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23  WEST  MAIN  STREET 

WEBSTER,  N.Y.  14580 

(716)  873-4503 


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CIHM/ICMH 

Microfiche 

Series. 


CIHM/ICIVIH 
Collection  de 
mxrofiches. 


Canadian  Institute  for  Historical  Microreproductions  /  Institut  Canadian  de  microreproductions  historiques 


"VfiS 


Technical  and  Bibliographic  Notas/Notas  tachniquas  at  bibliographiquaa 


to 


Tha  Instituta  haa  attamptad  to  obtain  tha  bast 
original  copy  availabia  for  filming.  Faaturas  of  this 
cofiy  which  may  ba  bibliographically  uniqua, 
which  may  altar  any  of  tha  imagas  in  tha 
raproduction.  or  which  may  significantly  changa 
tha  usual  mathod  of  filming,  ara  chackad  balow. 


□    Coloured  covers/ 
Couvarture  da  couleur 


I      I    Covers  damaged/ 


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D 


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Couverture  endommagte 


Covers  restored  and/or  laminated/ 
Couverture  restaur^  et/ou  pelliculAe 


1^    Cover  title  missing/ 


Le  titre  de  couverture  manque 


r~|    Coloured  maps/ 


Cartes  giographiquas  en  couleur 


Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 


nn   Coloured  plates  and/or  illustrations/ 


Planches  et/ou  illustrations  en  couleur 

Bound  with  other  material/ 
ReliA  avac  d'autres  documents 


/|    Tight  binding  may  cause  shadows  or  distortion 
^  '    along  interior  margin/ 

La  re  liura  serr6e  peut  causer  de  I'ombre  ou  de  la 
distortion  le  long  de  la  marge  intirieure 


Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
II  se  peut  que  certainas  pages  blanches  ajouttes 
lors  d'une  restauration  apparaissant  dans  la  taxte. 
mais.  lorsque  cela  itait  possible,  ces  pages  n'ont 
pas  tti  filmtes. 

Additional  comments:/ 
Commentaires  suppiimantaires; 


L'institut  a  microfilm*  le  meilleur  exemplaire 
qu'il  lui  a  M  possible  de  se  procurer.  Les  details 
da  cat  exemplaire  qui  sont  peut-Atre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite.  ou  qui  peuvent  exiger  une 
modification  dans  la  mithoda  normale  de  filmage 
sont  indiqute  ci-dessous. 


I      I   Coloured  pages/ 


n 


Pages  de  couleur 

Pages  damaged/ 
Pages  endommagtes 

Pages  restored  and/oi 

Pages  restaur^as  et/ou  peliicuites 

Pages  discoloured,  stained  or  foxei 
Pages  dicolories,  tachetdes  ou  piquAes 

Pages  detached/ 
Pages  ddtach^es 

Showthroughy 
Transparence 

Quality  of  priri 

Qualiti  in6gale  de  ('impression 

Includes  supplementary  materii 
Comprend  du  material  supplimantaire 

Only  edition  available/ 
Seule  Mition  disponible 


r~n  Pages  damaged/ 

I      I  Pages  restored  and/or  laminated/ 

ry\  Pages  discoloured,  stained  or  foxed/ 

I      I  Pages  detached/ 

r~n  Showthrough/ 

I      I  Quality  of  print  varies/ 

|~~|  Includes  supplementary  material/ 

I     I  Only  edition  available/ 


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Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc..  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  par  un  feuillet  d'errata.  une  pelure, 
etc.,  ont  M  filmies  i  nouveau  de  fa^on  d 
obtenir  la  meilleure  image  possible. 


This  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  film6  au  taux  da  reduction  indiqu*  ci-dessous. 


lOX 

14X 

18X 

22X 

26X 

lOX 

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12X 


16X 


24X 


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32X 


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The  copy  filmed  h«r«  hat  been  reproduced  thanka 
to  the  generoaity  of: 

N«w  Brumwick  MuMum 
Saint  Jolin 

The  imagea  appearing  here  are  the  beat  quality 
poaaibie  conaiderihtf  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  apecif icationa. 


Original  copiea  in  printed  paper  covera  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  laat  page  with  a  printed  or  iiiuatrated  imprea- 
sion.  or  the  back  cover  when  appropriate.  All 
other  original  copiea  are  filmed  beginning  on  the 
firat  page  with  a  printed  or  iiiuatrated  imprea- 
sion,  and  ending  on  the  laat  page  with  a  printed 
or  iiiuatrated  impreaaion. 


The  laat  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  ^»>  (meaning  "CON- 
TINUED"), or  the  symbol  V  (meaning  "END"), 
whichever  applies. 

IVIaps.  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  expoaure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


r  't 

t 

3 

L'exemplaire  film*  fut  reproduit  grice  A  la 
giniroait*  de: 

Ntw  Brunswick  Mufsum 
Saint  John 

Lea  imagea  auivantes  ont  At*  reproduites  avec  le 
piua  grand  aoin,  compte  tenu  de  la  condition  at 
de  la  nettet*  de  l'exemplaire  film*,  et  en 
conformft*  avec  lea  conditiona  du  contrat  de 
filmage. 

Lea  exemplairea  originaux  dont  la  couverture  en 
papier  eat  imprim*e  aont  fllmte  en  commen^ant 
par  le  premier  plat  et  en  terminant  aoit  par  la 
dernidre  page  qui  comporte  une  empreinte 
d'impreaaion  ou  d'illustration,  soit  par  le  aeeond 
plat,  salon  le  caa.  Tous  lea  autrea  exemplairea 
originaux  sont  film*s  en  commenpant  par  la 
premiere  page  qui  comporte  une  empreinte 
d'impreaaion  ou  d'iliustration  et  en  terminant  par 
la  derni*re  page  qui  comporte  une  telle 
empreinte. 

Un  dea  aymboiea  suivanta  apparaltra  sur  la 
derni*re  image  de  cheque  microfiche,  selon  le 
cas:  le  symboie  — »•  signif le  "A  SUIVRE",  le 
symbole  y  signifie  "FIN". 

Les  cartes,  planches,  tableaux,  etc.,  peuvent  *tre 
filmte  *  des  taux  de  reduction  diff*rents. 
Lorsque  le  document  est  trop  grand  pour  Atre 
reproduit  en  un  seui  ciich*,  ii  est  film*  *  partir 
de  i'angle  sup*rieur  gauche,  de  gauche  *  droite, 
et  de  haut  en  bas,  en  prenant  ie  nombre 
d'imagea  n*ces8aire.  Lea  diagrammes  suivanta 
illustrent  la  m*thode. 


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ASIA 


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HOLERA> 


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^1? 


ASIA,  AFRICA,  AND  EURQXE,^ 


IKTBODUCTXOK  INTO 


AMERICA  THROUGH  CANADA; 


EEMOTE  AND   PROXIMATE   CAUSES, 
SYMPTOMS  AND  PATHOLOGY, 

AND    THE 

VARIOUS  MODES  OF  TREATMENT  ANALYZED.      / 


By  R.  nelson,  M.D., 

Health  CommlMioner  during  the  first  two  invasions,  1832, 1831;  President  of 
the  Medical  Board  for  the  District  of  Montreal. 


NEW  YORK: 
WILLIAM  A.  TOWNSEND,  PUBLISHER, 

434  Bboosie  Stbeet. 
1866. 


r/V\ 


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Y  'A  1"  '■ 


wintered  MCQrdlng  tp  Act  of  Congrem,  in  the  yefir  1806,  tor 

B.    NELSON.   M.D.,  ^ 

In  the  Clerk's  Office  of  the  District  Court  of  the  United  States  for  the  Southern 

District  of  New  Tork. 


John  Mbdolb,  Printer, 
No.  193  Fearl  Street,  N.  Y. 


%■     ■ 


x\. 


./ 


PREFACE. 


It  was  through  medical  jotiniald,  commencing  in 
1820,  that  my  attention  was  first  draurn  to  the  cholera 
of  India,  said  to  prevail  in  an  epidemic  form,  and  to 
its  subsequent  spread  through  the  rest  of  Asia,  the 
east  of  Africa  and  into  Europe,  even  into  the  western 
confines  of  the  latter  continent.  In  the  abisence  of 
personal  observation,  I  became  as  thoroughly  conver- 
sant with  the  malady  as  reading  could  afford  informa- 
tion. But  I  could  not  help  being  struck  with  the 
great  discrepancy  in  opinions  and  doctrines  promul- 
gated. On  one  point  only  all  were  in  perfect  accord; 
that  point  was  one  of  patent  fact— a  description  of 
the  appearance  of  a  patient  and  the  phenomena  man- 
*  ifested  in  every  case.  In  all  other  respects  they  all 
disagreed,  as  doctors — doctors  in  medicine  and  doc- 
tors in  theology — only  cati  differ  and  argue. 


iv 


PREFACE. 


Thus  prepared  by  reading,  and  rendered  skeptical 
bj  conflicting  doctrines  and  opinions,  I  entered  upon 
the  du4es  of  my  office.  Daily  reports  were  sent  in  to 
the  Board  of  Magistrates,  and  to  my  office  as  execu- 
tiye  officer  of  the  Medical  Board,  from  practitioners, 
and  other  sources  of  information.  It  will  bo  admitted 
that  under  these  circumstances  I  was  favorably  placed 
to  become  well  acquainted  with  the  pest  from  its  first 
appearance  in  America,  in  1832,  and  the  second  inya- 
sion  in  1834,*  nor  have  I  remained  unmindful  of  subse- 
quent irruptions. 

Of  the  contents  of  this  book  I  have  often  spoken, 
for  years  past,  with  medical  men,  and  as  often  have 
been  urged  to  publish  my  views.  I  do  so  now,  princi- 
pally to  fix  a  point  in  history: 

The  introduction  of  a  new  malady  into  a  new  coun- 
try ^  and  to  record  the  experience  I  acquired  in  the 
beginning,  and  which  has  been  confirmed  by  every 
case  since  then.  Many  of  my  statements  come  into 
direct  collision  witb  those  of  previous  and  even  of 
present  writers.  The  only  apology  I  can  ofifer  for 
the  difference  is,  mine  are  the  result  of  personal 
observations  carefully  made  on  the  patient,  unbiassed 
by  abstract  theories,  and  an  erroneous  physiology, 


PREFACE.  V 

which  possesses  nothing  in  common  with  Asiatic 
cholera. 

R.  NELSON. 


P.  S.  Since  writing  this  book,  some  of  my  state- 
ments have  met  with  corroboration  this  present  sea- 
son, namely:  Ist.  Cholera  broke  out  on  board  a 
French  vessel  a  few  days  out  of  port.  It  soon  had 
selected  its  victims,  and  then  ceased;  the  remainder 
of  the  passage,  which  was  of  some  weeks'  duration,  was 
completed  in  perfect  health,  when  the  vessel  arrived 
at  Guadaloupe,  all  well.  2d.  An  apparently  healthy 
ship  and  passengers  enter  a  new  (land)  atmosphere, 
and  within  a  day  or  two  the  pest  breaks  out  among 
the  passengers  who  had  escaped  the  pestilence  on 
board,  and  communicate  it  to  a  healthy  people, 
among  whom  it  makes  dreadful  ravages.  (See  Sections 
66, 67, 74, 87,  88.)  M,  Two  steamers,  from  England, 
experience  an  outbrtak  on  board  a  few  days  after 
leaving  port.  (Sec,  78,)  But  the  vessels  arrive  with 
cholera  still  on  board;  the  passage  being  of  only  two 
weeks'  duration,  the  pest  had  not  the  usual  period  of 
time  to  select  all  the  susceptible,  and  then  cease, 
One  put  into  Halifax,  is  placed  in  seclusion,  an4  now, 


MteMMUUMirfM 


Ti 


PREFACE. 


in  a  new  (land)  atmosphere,  renews  its  activity,  as  has 
ever  been  the  case.  Some  passengers  escape  from  the 
quarantine  inclosure,  travel  rapidly  through  a  per- 
fectly healthy  country,  take  ill  and  die  in  the  new 
atmosphere.  These  three  vessels  afford  several  other 
points  corroborative  of  my  statements,  but  which  I 
do  not  notice,  that  I  may  not  enlarge  this  book  use- 
lessly. 

R.  N. 


I  N"  DEX. 


Adipose  tissue  diminished,  20(t;  Omentum,  200. 
Aeration  of  blood  arrested,  IIH. 
Animals  attacked— A  horse,  170;  Poultry,  Fishes,  177. 
Ascites,  hydroth'irax,  etc.,  drained  away,  204. 
Atmosphere — Choleraic,  41;  Cholera  carried  by,  45;  Change 

of,  no  protection,  88;  While  in  infected,  less  risk, 

removal  to  a  healthy  one  injurious,  165. 
Attacks— Sudden,  57;  At  Suedie,  68;  While  riding,  106;  At 

breakfast,  57;  None  other  than  the  exposed,  208. 
Attack,  a  second  one,  172. 
Bile — Secretion  of,  arrested,  189. 

Blood,  165;  Quality  of,  194;  Salts  in,  19G;  Globules,  pro- 
.    portion  of,  explained,  194;  In  the  cyanosed  state,  186; 

Difference  between  healthy  and  choleraic,  194. 
Csesarean  operations,  126. 
Calorification  arrested,  121;  Temperature  reduced  to  70^, 

122;  Cold  breath,  124;  Interior  of  body  cold,  126; 

Stools  cold,  123;  A  warm  enema  returned  cold,  125; 

Saline  injections  cooled  in  passing  through  the  body, 

129;  Temperature  measured  by  thermometer,  128. 
Catalysis,  138. 


vili 


IKDIX. 


I' 


Gaoie,  remottf,  imporianoe  of  itndyiug,  29;  Attributed  to 
the  atmoipUcro,  41;  Absnrd  opinions,  42;  Humid 
miaama,  44  to  47;  Low  grounds  and  high  make  no 
differenoe,  40;  Dry  places,  61,  52,  64;  High  land- 
Mysore,  Ohants,  Ararat,  Lebanon,  Caucasus,  Him- 
malayaa,  eto.,  02. 

Cholera— Comwitf/i,  02;  Cases,  95,  96,  97,  98,     '  '< 

Cholera— Asiatic,  109. 

Cholera— Carried  by  oararan  8,  73. 

Cholera— Carri(*d  by  ships  to  Muscat,  61;  By  frigate  Topaz 
to  MauritiUM,  60;  By  Pic-Var  to  St.  Denis,  67;  By 
frigate  Leander  to  Trinohimallee,  74;  By  a  brig  to 
Astraohan,  76;  By  frigate  Abercrombie,  76;  To  Col- 
lapore,  77;  By  French  frigates  Cyb^Ie  and  Cl^opatre, 
78;  By  mercantile  fleet  into  Canada,  147;  The  Bobert 
from  Cork,  148;  Constantia  from  Limerick,  Elizabeth, 
Carriok,  brig  Brutus,  ship  Brutus,  148;  By  canal 
boatfl,  68;  By  pest  steamer  Voyageur,  155;  By  troops, 
66. 

Cholerine  and  diarrhcea,  113. 

Choleraio  poiaon  oonverts  a  portion  of  the  system  into  the 
liquid  form,  210. 

Choleraio  Poinon  ItfAYti  no  pathological  trace,  103. 

Cholera,  ooma  of,  all  alike,  109, 110,  111,  114. 

Cholera,  oaaoR  of,  rapid,  115. 

Cholera,  eaaas  of,  mild,  111,  112. 

Cold  country  ot  aituation  made  no  difference,  Moscow, 
North  of  Bttrope,  Edinburgh,  21,  et  seq. 

Circulation  arrestud,  110;  Capillaries  cease  to  act,  189;  Ar>- 
teriof  and  Telns  equally  filled,  190.  ^ 


<y 


INDEX. 


IX 


Cleanliness  no  preventive— Palace  of  a  prince,  79;  Among 
the  wealthy,  161,  162;  Mortality  among  the  wealthy 
statistically  greater  than  among  the  lower  orders,  162. 

Compound  radical  theory,  216,  217,  218. 

Congestion  in  cranium,  191 ;  A  convenient  word,  192. 

Conquest  arrested,  89. 

Contagionists,  Non-,  39. 

Contagion— see  Itinerary;  carried  to  Pan  well  by  a  prisoner, 
59;  By  Caravans,  73;  See  ships,  boats,  troops,  etc., 
56,  60;  Carried  by  clothing,  62,  63;  Oreat  fair  at  Nij- 
ne-Novgorod,  65;  By  a  bed,  158;  By  a  raft,  158;  By 
a  drover,  158;  By  a  canal  boat,  158;  Miss  Hughes, 
173;  By  immediate  intercourse,  159;  From  person  to 
p'^Tson,  55;  Dr.  Labrousse  at  Bourbon,  67. 

Cramps,  132. 

Cures  supposed  to  have  been  made,  259. 

Cyanosis  due  to  non-aeration,  118;  Stasis  of  blood  in  rete 
malpighit  140;  Soon  disappears  in  short  cases,  141; 
Persists  purple  in  <' typhoid  state,"  110. 

Curious  catalogue  of  reputed  remedies,  220. 

Digestion  arrested,  120. 

Disease,  definition  of,  101 ;  Asiatic  cholera  not  a  disease,  but 
simply  a  poison,  92.  , 

Drunkards  escape,  90,  162. 

Duration  of  cholera  in  one  place,  86,  87,  88. 

Enclosed  places  escape,  Gurruckpore  jail,  66;  Baron  Me- 
lius, 67;  In  Montreal,  180. 

Erroneous  physiology,  184,  185,  222. 

Exclusion. by  the  Moravians,  and  escape,  68;  Sequestration 
of  houses  in  Moscow,  69;  M.  de  Lesseps  in  Egypt, 


\. 


IKDEX. 


i-^i.; 


70;  Passes  at  Sankerredroog,  71;  Teheran,  73;  Han- 
gheet  Sing,  82.  '^s.  , 

Exudation  through  the  skin,  not  perspiration,  1B7;  a  colli< 
quate  oozes  out,  208,  209. 

Galvanism  useless,  238. 

Garrison  at  Montreal,  174.  ^  , 

Infection,  range  of,  85;  How  soon  manifest,  78. 

Inflammation  cannot  be  excited,  197;  Of   semilunar  gan- 

V^      gUon,  198.    '  r^ 

Itinerary  in  Asia,  Africa  and  Europe,  1  to  28;  In  Canada, 
U4  to  183. 

Incubation  before  out-break,  78,  86;  Seldom  exceeds  four 
days,  108;  On  shipboard,  148,  155,  212.  i 

Heart,  187;  Liver,  201;  Spleen,  202;  Kidneys,  203. 

Mental  faculties  remain  perfect,  142;  Perverted  sensation 
of  heat,  117,  131. 

Not  exempt — medical  practitioners  and  nurses,  etc.,  39;  Pa- 
tient with  variola,  fever,  etc.,  264. 

Quarantine  in  Canada,  145  to  150.  r 

Serous  membranes  all  dry,  204. 

Secretions  arrested,  why,  133;  Varicose  ulcers,  sinuses, 
gonorrhoea,  cease  to  secrete,  204. ;  Of  bile,  139;  Of 
urine  suppressed,  why,  133. 

Beligion  as  a  prophylactic  by  the  king  of  Siam,  83;  propa- 
gated by  the  ceremonies  of,  80;  Juggernaut,  81, 
Mecca,  84,  Canada,  137. 

Strangury  explained,  135;  Not  in  females,  136. 

Stomach  and  intestines  contracted,  199. 

Thirst,  cause  of,  143.  \ 


INDEX. 


Treatment,  220;  Examined  in  detail,  223;  bleeding,  223; 
Calomel,  225;  Emetics,  228;  Pnrgatiyes,  230;  Enemas, 
233;  Metastasis,  226;  Sinapisms,  epispastics,  cautery, 
red-hot  iron,  scalding  water,  nitric  acid,  227;  Seda- 
tives, 232;  Opinm  abused,  234;  Stimulants,  234;  Bath, 
-warm,  235;  Astringents,  236;  Drinks,  237;  Quinine, 
per  Oram  et  anum,  239;  Acupuncture  of  the  heart, 
238;  Charcoal,  240;  Oxygen  gas,  nitrons  oxide,  241; 
Chloroform,  242;  Saline  venous  injections,  243:  Effect 
of  injections,  244,  245, 246,  247;  Farrago  of  treatment 
completed,  248. 

Treatment,  sound:  Opium,  merits  of,  249, 250;  Drinks,  made 
of  tartaric  acid,  352;  Hot  applications,  254;  Cold 
bath,  255;  Medical  treatment  uncertain  and  confused, 
256;  Dialogue  between  Honesty  and  Pretence,  257; 
Expectant  treatment,  258 ;  Quietude  necessary  to 
arrest  vomiting,  260,  261;  Opiate,  proper  time  to 
give,  262;  Proper  quantity,  263;  Diarrhoea-cholerine 
treated,  264,  265. 

Vox  cholerica,  130. 


t  I 


ASIATIC  CHOLERA. 


CHAPTER  I. 


ORIGIN  AND  ITINERABT. 


The  19  th  century  is  remarkable  for  the  great 
events  that  have  taken  place  since  its  commencement, 
and  a  short  time  previously.  In  it  the  knowledge  of 
steam,  its  powers,  the  means  of  controlling  it,  its  uses 
ad  a  substitute  for  bodily  and  manual  labor,  and  its 
complete  obedience  to  the  hand  of  man,  have  been 

I  perfected.  > 

Chemistry,  already  iii  its  infancy,  has  become  an 

[exact  science* 

Electricity  and  magnetism  have  advanced  from 

[being  mere  toys  to  a  grade  of  the  highest  utility. 

[Geology  has  disinterred  the  long  buried  almanac  of 

[the  globe,  brought  clearly  into  light  the  reign  of  ex- 
tinct creations,  overwhelmed  and  hidden  since  mil- 
lions of  years  have  passed  away^    These  are  only  a 


li 


ASIATIC   CHOLERA. 


few  of  the  remarkable  occurrences;  but  the  one  which 
distinguishes  this  century  more  than  all  others  of 
which  history  makes  mention,  in  relation  to  man,  is 
the  stupendous  plague  called  Cholera.  Stupendous 
from  its  wide  spread  malignancy  over  every  conti- 
nent; stupendous  from  the  millions  of  victims  it  has 
swallowed;  stupendous  from  the  rapidity  of  its 
spread;  stupendous  from  the  few  brief  moments  of  life 
it  allows  to  those  it  attacks:  apparently  capricious 
in  its  selections,  it  has  desolated  some  places,  spared 
others;  terrified  nations,  arrested  the  march  of  armies, 
turned  conquest  into  defeat,  laughed  at  science,  and 
baffled  the  efforts  of  man  to  arrest  its  empire. 

1,  Sporadic  cases  of  cholera  have  been  known  in 
all  historic  ages,  from  that  in  which  the  great  Hip- 
pocrates flourished  until  now,  and  is  mentioned  in  all 
treatises  of  medicine.  In  India  it  has  been  long 
known.  Bontius,  Llnd,  Dellon,  &c.,  almost  all 
writers  on  the  diseases  of  that  country,  make  special 
mention  of  it.  It  is  said  to  have  prevailed  in  an  epi- 
demic form  in  the  Bengplese  territory  in  1762,  when 
it  carried  off  30,000  natives  and  800  Europeans  in 
one  season,  and  then  ceased.  ^  ,  c 

2.  A  more  recent  account  says  that  the  Govern- 
ment  of  India  became  cognizant  of  an  increase  of  the 
malady  among  the  natives  ten  years,  at  least,  before 
it  assumed  the  character  of  terrible  devastation  that 


t 
s 


ORIGIN  AND  iTINEBABf. 


u 


distip^uished  it  in  1817;  while,  in  all  these  ten 
years,  not  one  case  occurred  among  the  European 
population,  and  during  that  period  not  one  case  was 
admitted  into  the  General  Hospital  of  Calcutta.  It 
still  maintained  the  simple  and  sporadic  character 
noticed  for  many  years;  that  is,  single  cases,  here 
and  there,  now  and  then,  happened  apparently  spon- 
taneously and  without  assignable  cause,  not  spread- 
ing from  one  to  another  individual,  and  still  less  ex- 
isting as  an  epidemic. 

3.  The  Government  of  Bengal  was  officially  in- 
formed on  the  28th  of  August,  1817,  that  a  sudden, 
violent  and  spreading  irruption  of  cholera  had  oc- 
curred in  the  populous  town  of  Jessore,  the  capital 
of  the  Sunderbunds,  situated  in  the  delta  of  the 
Ganges,  silty  miles  from  Calcutta;  and  that  10,000 
of  the  inhabtitants  had  died  in  a  few  weeks.  The 
report  stated:  "  The  inhabitants,  astonished  and  ter- 
rified at  the  unaccountable  and  destructive  pesti- 
lence, fled  in  crowds  to  the  country  as  the  only 
means  of  escaping  impending  death.  So  unforeseen 
and  appalling  was  the  attack,  the  public  function- 
aries, in  extreme  consternation,  closed  the  civil 
courts  of  the  district,  and  business  of  every  descrip- 
tion was  abandoned  for  a  time.  In  the  course  of  a 
few  weeks  10,000  of  the  inhabitants  perished  in  this 
single  district.'' 


n 


16 


ASIATIC  CHOLERA. 


It  reached  Calcutta  on  the  1st  of  September, 
whence  it  spread  like  radii  from  a  centre  to  all 
points  of  the  compass.  ' 

4.  Although  its  origin  is  generally  located  at  Jes- 
sore,  it  is  asserted  that  it  ravaged  the  banks  of  the 
Burrampooter  early  in  June,  reached  Silket,  in  the 
east,  and  spread  to  the  confines  of  Balasore  and  the 
provinces  of  Behar,  in  the  east.  To  the  northwest 
of  Jessore  it  attacked  Patna  and  Dinapore,  July 
11th.  Following  the  course  of  the  Ganges  and  its 
tributaries,  it  reached  and  attacked  the  camp  of  the 
Marquis  of  Hastings,  in  Bundelcund,  on  the  banks  of 
the  Sinde,  a  tributary  of  the  Jumna,  on  the  6th  No- 
vember. The  invasion  was  so  sudden  and  violent 
that  mounted  men  were  stricken  from  their  steeds, 
fell  and  died  on  the  road.  The  roads  were  encum- 
bered with  ill,  dying  and  dead  of  the  army,  and  its 
followers,  more  numerous  about  an  Indian  army  than 
the  army  itself.  But  this  irruption,  though  astound- 
ing, was  soon  over;  for,  having  commenced  on  the  6th 
November,  no  new  cases  occurred  in  the  camp  after 
the  8th  December.  However,  the  pestilence  still  fol- 
lowed in  the  track  of  the  army,  or  rather  the  army 
Bowed  its  seeds  all  along  the  roads,  rivers,  and  ways 
of  travel,  infecting  village  and  town  in  succession 
throughout  Bundelcund,  and  spread  to  the  provinces 
of  Behar,  Malwah,  Candish,  overshadowing  nearly 


ORIGIN  AND  ITINERARY. 


17 


all  the  Deccan.  It  killed  10,000  in  the  town  of 
Banda,  and  all  the  neighboring  towns  were  similarly 
oppressed.  One  of  these  towns,  Kotah,  lies  on  the 
east  side  of  the  Chumbul,  and  is  built  upon  a  dry 
rock;  but  the  aridity  of  the  location  aflforded  no  san- 
itary protection,  since  100  persons  perished  daily; 
the  surviying  inhabitants,  struck  at  last  with  dismay, 
fled  the  city. 

6.  Two  offshoots  of  the  pestilence  appear  to  have 
set  out  from  the  town  of  Saugur,  the  westerly  one 
going  to  Eotah,  and  the  southern  one,  going  due 
south,  attacked  the  forces  stationed  on  the  Nerbundah, 
advanced  through  the  states  of  Nagpore  and  Poonah, 
passed  through  Seringapatan  to  the  extreme  point  of 
India.  The  westerly  one  from  Eotah  followed  the 
coast  of  Malabar.  An  eastern  branch  followed  the 
coast  of  Goromandel. 

6.  Each  of  these  offsets  invaded  town  after  town, 
village  after  village  in  succession,  regardless  of  topog- 
raphy, high  or  low  land,  mountain,  plain  or  swamp; 
nor  was  the  high  Ghaut-range  capable  of  presenting 
a  barrier  to  its  destructive  march. 

7.  Northwardly  it  reached  Fyzabad  and  Lucknow 
in  April  and  May,  1818.  At  Gurruckpore  it  carried 
off  30,000  of  the  inhabitants,  while,  during  this  ap- 
palling devastation,  not  one  of  the  prisoners  confined 
in  the  jails  took  the  pest.    The  high  mountains  that 


18 


ASIATIC)   CHOLERA. 


separate  Hindostan  from  Nepaul  were  invaded,  as 
well  as  the  high  table  land  of  Patna  and  Rhatgoun, 
4,000  feet  aboye  the  sea;  Eatamaudoo,  in  Nepaul, 
was  attacked  in  1818,  and  also  the  south  flank  of 
those  almost  impassable  heights;  and  in  1819  it 
broke  out  in  Slam,  Cochin  China,  beyond  that  range. 

8.  In  October,  1818,  Madras  suffered,  and  thence 
cholera  reached  Candy,  the  capital  of  Ceylon,  at  a 
great  height  above  the  sea,  in  December.  Com- 
mencing at  the  coast,  it  spread  to  the  interior  of  the 
island. 

9.  We  have  now  traced  the  course  of  the  pesti- 
lence from  its  cradle  in  the  Sunderbunds,  eastwardly 
to  the  confines  of  Cochin  China;  northwardly  to  the 
Himmalayas;  westwardly  to  Bombay;  and  south- 
wardly to  Cape  Comorin,  and  into  the  island  of 
Ceylon.  Let  us  now  follow  its  course  beyond  India 
over  the  sea  into  Sumatra,  Borneo,  the  Moluccas,  and 
the  Philippines,  into  China. 

10.  Malacca,  the  extreme  southern  point  of  the 
Birman  Empire,  was  attacked  August,  1818;  the  pesti- 
lence was  carried  over  to  the  island  of  Penang  in 
the  Straits;  and  in  1819  it  spread  through  Sumatra. 
The  town  of  Batavia  alone  lost  17,000,  and  the  whole 
island  102,000,  according  to  the  Dutch  statistics.  Java 
suffered  in  April,  1821.  The  destruction  in  these 
places,  like  in  Borneo,  was  appalling, 


ORIGIN  AND  ITINERARY. 


19 


11,  Manilla  was  attacked  early  in  1820,  where  the 
death  of  15,000  victims  alarmed  the  people  to  fury, 
who  rose  up  against  the  foreigners  and  made  a  fright- 
ful massacre  of  them. 

12,  Traveling  northwardly  the  cholera  reached 
Canton  in  1820.  Bankok,  in  Slam,  lost  40,000  in 
1819.     Nankin  and  Pekin  suffered  in  1823. 

13,  Southwesterly  traveling  across  the  sea  it  in- 
vaded the  African  islands,  Mauritius  and  Island  of 
Bourbon.  The  Topaz  frigate,  from  Calcutta,  anchored 
in  Port  St.  Louis,  Isle  of  France  (Mauritius),  at  the 
end  of  November,  1819.  Several  of  the  crew  had 
died  of  cholera  on  the  passage.  The  captain  refused 
to  submit  to  quarantine;  his  people  landed,  infected 
the  town,  carrying  off  2Q,000.  (But  the  governor, 
Farquhar,  perhaps  to  screen  the  captain  of  his 
haughty  disobedience  of  the  quarantine  laws,  re- 
ported the  number  at  7,000  or  8,000.)  By  strict 
measures  adopted,  the  remainder  of  the  island  was 

i  spared. 

14,  Baron  Melius,  the  French  governor  of  the 
adjacent  island,  Bourbon,  at  once  interdicted  all  com- 

j  munication  with  his  colony.  Still,  in  spite  of  severe 
but  wise  measures  of  the  governor,  the  pestilence 
was  brought  there  by  the  cupidity  of  a  trading  vessel, 
Pic-Var,  which  left  Mauritius  July  7,  1820.  On  the 
14th  cholera  broke  out  at  St.  Denis.  The  inhabitants 


I 


ASIATIC   CHOLERA. 

fled  at  once;  the  authorities  eurrounded  the  place 
with  sentinels,  kept  up  a  most  vigilant  seclusion. 
Success  was  the  result  and  the  reward ;  the  pest 
spread  no  further  into  the  country;  it  was  confined  to 
the  town,  in  which  259  were  attacked,  of  whom  178 
died. 

16.  August  6th,  1818,  it  reached  Panwell,  separ- 
ated from  Bombay  by  a  strait  crossed  daily  by 
boats.  On  the  9th  a  passenger  from  Panwell  intro- 
duced the  pestilence  into  Bombay  and  Salsette, 
whence  it  spread  along  the  whole  coast  of  Malabar. 

16.  By  the  extensive  commerce  of  Bombay  it  was 
carried  across  the  gulf  to  Muscat,  in  July,  1821.  It 
soon  broke  out  in  the  islands  of  Ormus  and  Kishme, 
at  the  entrance  of  the  Persian  Gulf;  and  by  August 
it  extended  up  the  coast  to  Bender- Abassi,  where  the 
destruction  was  so  great  that  the  bazaars  were  closed, 
houses  abandoned,  and  the  dead  lay  in  heaps  un- 
buried  in  the  streets.  September  6th  it  broke  out  at 
Shiraz,  a  hundred  miles  up  the  coast;  here  one  of  the 
first  families  attacked  was  that  of  the  Prince  Royal 
of  Persia.  One  of  his  wives,  his  mother,  and  many 
Georgian  beauties  in  his  seraglio,  besides  some  of  his 
children,  were  carried  oflf.  The  mortality  was  6,000 
out  of  a  population  of  35,000.  He  fled,  with  his  harem 
and  suite,  from  the  fury  of  the  pestilence, 

17.  Continuing  its  northwardly  route  it  invaded 


ORIOm  AND  ITINERARY. 


21 


the  towns  of  Yerd  and  Ispahan,  whore  25,000  fell  its 
victims.  Cachan,  Koms  and  Toheran  suflfeied,  on  its 
way  to  Tauris,  in  1822.  Boats  carried  it  to  Bassoia 
and  Bagdad,  where  it  swept  away  one-third  of  the 
population.  In  July  it  infected  Mosul,  north  of 
Bagdad,  marched  westward  into  Syria,  and  broke 
out  at  Aleppo,  in  November,  1822,  spreading  to  An- 
tioch,  etc.,  along  the  coast  of  the  Mediterranean  to 
Tripoli. 

18.  Ascending  the  Caspian  Sea  it  reached  Astra- 
chan,  near  the  mouth  of  the  Volga,  in  September, 
1823,  where  the  attacks  and  deaths  were  rapid.  The 
Russian  Government  sent  at  once  six  medical  officers 
to  examine  into  the  disorder;  it  also  took  wise,  ener- 
getic and  absolute  measures  to  prevent  it  from 
ascending  the  river.  These  measures  were  effective 
for  a  while;  but  commerce  broke  down  the  barriers. 
An  infected  brig  from  Bakou,  on  the  west  coast  of 
the  Caspian,  entered  the  Volga  July  20, 1830,  gave 
the  disorder  to  Astrachan  a  second  time,  where  4,043 
died.  It  spread  to  Sarutof,  August  12;  Samara  was 
infected  September  3d,  Kazan  the  9th,  and  by  the 
12th  a  few  cases  appeared  iu  Moscow. 

19,  We  will  not  follow  its  other  eastern  route 
through  Russia  to  Nyne-Novogorod,  where  it  broke 
out  August  27th,  and  thence  spread  through  the  centre 
of  Russia.    There  is  some  uncertainty  whence  this 

2* 


22 


AIIATIO  CHOLERA. 


irruption  carno.  Bomo  assert  that  it  was  duo  to  the 
great  annual  fair  of  100,000  merchants  as-einbled  to 
purchafio  the  coNtly  shtiwls  and  furs  that  came  from 
Oreuburgh— ^oods  that  had  been  infected  and  lay 
there  Binco  tho  previous  year;  others  say  that  it  might 
have  been  brought  by  travelers  from  Saratof,  where 
it  raged  flftoon  days  before.  SeptemV  ■;]  3( !  it  reached 
Kostroma,  and  many  towns  and  vflip^'eu  oa  the  route 
to  Moscow. 

80.  By  another  route  it  crossed  from  the  Volga, 
where  this  river  appioachcs  tho  Dun,  and  descended 
this  last  nairiod  river  to  the  Sea  of  Azof  and  the  Blacic 
Sea  coast  in  Hoptomber,  reaching  Sebastopol  in  Octo- 
ber, and  broke  out  in  Kischrif  in  December.  Its 
ravages  among  tho  Cossaclcs  of  the  Don  were  fright- 
ful; out  of  54,000  cases  31,000  died— that  is,  out  of 
seven  p&tiouli  six  died  I 

31.  About  tho  end  of  September,  1830,  cholera 
broke  out  at  Moscow.  On  the  29th  a  military  cordon 
was  estabiishod  around  the  city,  whose  ofiice  was  to 
prevent  egrosi  and  ingress.  Strict  quarantine  was 
exacted  of  all— oven  the  Emperor  himself  obeyed  the 
law,  and  dit^h.s'^imi  eight  days'  quarantine  on  his 
road  to  7  ^vtir.  A^urtality  was  great  here  throughout 
October  and  November,  but  diminished,  as  usual, 
after  a  while,  by  the  18th  December.  The  popula- 
tion was  250,000,  of  which  8,130  died,  equal  to  one  in 


OBIOIN  AND   ITINERARY. 


28 


jqual  to  one  in 


25,  a  much  smaller  number  than  was  expected;  but 
this  diminution  was  due  to  the  cordon,  t!»€  strict  mili- 
tary (H  ^ipline  and*  quarantine,  and  lo  the  closure  of 
infected  houses  and  places.  A  triple  lino  of  posts 
preser/ed  St.  Petersburg.  Orders  were  sent  to  the 
people  to  lay  in  provisions  for  at  least  one  ^»ar,  to 
meet  the  wants  of  seclusion,  should  tliat  ^.  -come 
necessary. 

22.  The  disorder  still  existed  in  January,  ctl^o^ifli 
a  severe  winter  had  frozen  all  travel  and  co  nrauni* 
cation.  Still,  all  the  sanitary  reg  ilatious  wcr.  k  , 
up  until  the  end  of  April,  in  consequence  ol  '  ' 
perience  gained  at  Kiew  where,  the  disorder  h;  ng 
ceased  in  November,  all  restrictions  were  ren.u  I; 
but  unfortunately  so,  for  only  fifteen  days  after  le 
relaxation  of  all  restriction  it  broke  out  again,  n 
the  1 5th  December. 

23.  The  Russian  army  moving  on  Poland  was  1||i 
rapid  means  of  carrying  the  pest  westwardly.  The 
troops  of  this  army  were  drawn  from  the  Ukraine 
and  the  provinces  of  Koursk,  where  cholera  had 
raged  the  previous  autumn.  The  violence  of  the 
plague  did  not  diminish  with  it  entry  into  a  northern 
climate,  for  in  April  and  May  more  than  half  of  the 
attacked  died,  and  this  frightful  proportion  was  ex- 
clusive of  the  military  loss.  Other  troops  coming 
from  Bender  and  the  shores  of  the  Dnieper  spread 


24 


ASIATIC    CHOLERA. 


the  pest  among  the  people  in  February.  With  this 
army,  cholera  entered  Poland  at  the  southeast  corner 
of  the  kingdom,  on  its  march  to  the  northwest,  its 
destination  being  Warsaw.  At  the  end  of  March  it 
ravaged  Lublin.  By  the  1st  of  April  the  hospitals  of 
Siedlee  became  crowded  with  patients  afifected  with 
cholera.  On  the  10th  it  broke  out  among  the  pris- 
oners and  the  wounded  brought  into  Praga,  a 
suburb  of  Warsaw,  on  the  opposite  side  of  the  Vis- 
tula. The  same  daj  it  was  discovered  in  the  Polish 
army  after  the  battle  of  Iganie,  proving  fatal  to  the 
conquerors  by  the  infected  spoils  collected  from  the 
slain  of  the  vanquished. 

24.  The  Russian  Government  appointed  kn  ex- 
traordinary committee  in  April,  whose  office  was  to 
discuss  and  decide  whether  it  was  necessary  to  have 
a  general  purification  of  the  goods  left  in  Moscow 
during  the  winter  after  the  cessation  of  the  plague 
there.  On  this  committee  there  were  several  mer- 
chants, besides  disinterested  scientific  men.  A  ma- 
jority was  to  decide.  It  is  easy  to  see  that  cupidity 
would  overpower  honesty;  accordingly  a  majority  of 
votes  decided  that  purification  was  unnecessary. 
Acting  on  this  dangerous  advice,  the  Government  is- 
sued a  circular  to  the  several  European  powers  to 
justify  its  conduct  in  not  purifying  these  goods  be- 
fore their  export.    The  result  soon  became  apparent, 


ORIOm  AND  ITINERARY. 


25 


for  the  boats  which  carried  these  goods  down  the 
Dwina  and  its  tributaries  to  Riga  carried  also  the 
contagion,  which  broke  out  in  Riga  25th  May. 

25.  With  the  irruption  of  the  fell  demon  there 
also  broke  out  alarm.  On  the  3d  June  sixty  vessels 
fled  in  haste  from  Riga,  and  forty-two  had  already 
passed  the  Sund.  Four  of  these  vessels  were  des- 
tined to  England,  and  one  that  was  infected  entered 
the  port  of  Montrose  in  Scotland,  where  cholera 
spread  lightly  in  June,  but  of  which  no  official  notice 
was  announced. 

36.  An  official  report  declared  that  306  cases  and 
94  deaths  had  occurred  in  Sunderland,  by  Octo- 
ber 26th. 

However,  Mr.  Hall,  surgeon  of  H.  M.  ship  Teme- 
raire,  an  hospital  ship  in  the  Medway,  says  that  be- 
tween the  7th  and  9th  August  he  had  thirty  cases, 
persons  of  all  ages,  even  to  infants  at  the  breast. 
Drafts  from  Portsmouth,  Plymouth,  etc.,  who  arrived 
to  join  the  men-of-war  here,  men  in  robust  health, 
took  the  disease  within  the  first  and  second  day  of 
their  arrival.  The  infected  ships  were  sent  into 
quarantine  at  Stangate,  ten  or  twelve  miles  distant, 
by  which  means  the  pest  was  prevented  from  spread- 
ing there  and  then. 

To  return  to  Sunderland,  it  is  affirmed  that  chol- 


26 


ASIATIC   CHOLERA. 


era  was  brought  into  that  town  through  clothing  col- 
lected from  the  dead  in  the  Baltic. 

27.  The  cold  winter  of  Northumberland  afforded 
no  obstacle  to  its  propagation;  even  Edinburgh  suf- 
fered in  February,  1832. 

28.  The  object  of  writing  this  book  is  to  record 
the  first  entry  of  a  new  pestilence  into  a  new  coun- 
try, to  be  substantiated  by  positive  and  precise  data. 
But  it  was  deemed  proper  to  precede  this  event  by  a 
few  words  on  its  origin  and  migration  towards  the 
"  New  World."  Therefore  it  is  that  we  have  given 
the  foregoing  rapid  sketch  of  a  pestilence  that  has 
spread  its  long  arms  to  the  four  points  of  the  com- 
pass, reaching  from  the  place  of  its  birth  in  the  Sun- 
derbunds  to  the  Baltic,  and  thence  into  England — 
the  hap-off  point  from  the  old  to  the  new  continent. 

However,  before  touching  on  the  history  of  its  ar- 
rival into  the  towns  and  parishes  on  the  St.  Law- 
rence, and  its  subsequent  spread  in  America,  we 
must  not  omit  a  summary  and  exposd  of  the  import- 
ant and  interesting  opinions  of  writers  on  its  origin 
or  remote  cause.  This  will  constitute  the  second 
chapter,  in  which  we  shall  have  to  repeat  much  of 
the  itinerary  already  stated  in  this  first  chapter. 
After  the  fourth  chapter,  we  shall  trace  it — lead,  as 
it  were,  by  the  hand— across  the  ocean  into  the 
"  New  World." 


bing  col- 


aflforded 
urgh  suf- 

to  record 
lew  coun- 
cise  data, 
vent  by  a 
wards  the 
ave  given 
1  that  has 
:  the  com- 
n  the  Sun- 
3ngland — 
ontinent. 
r  of  its  ar- 
j  St.  Law- 
lerica,  we 
he  iinport- 
lUs  origin 
;he  second 
at  much  of 
it  chapter, 
t — lead,  as 
a  into   the 


CHAPTER  ir. 


REMOTE  CAUSE. 


In  this  chapter  on  the  remote  cause  will  appear  a 
succinct  notice  of  opinion  set  forth  by  non  conta- 
gionists,  and  a  history  of  its  march  from  place  to 
place,  and  from  individual  to  individual,  proving  its 
contagious  character. 

29.  The  remote  cause  of  all  diseases,  especially  of 
pests,  is  the  most  important  point  to  become  ac- 
quainted with;  for  with  this  knowledge  the  practi- 
tioner will  know  what  precautions  ought  to  be 
adopted  against  the  disorder  and  its  spread.  With 
this  it  is  the  duty  of  the  magistrate  to  become  thor- 
oughly acquainted,  in  order  to  arrest  its  invasion  of 
his  country,  and  the  spread  of  an  infectious  disease 
among  his  people,  since  he  is  appointed  to  watch 
over,  care  for,  and  protect  them.  To  attain  this 
knowledge,  the  widest  range  of  research  and  discus- 
sion must  be  accorded  to  all  men  who  undertake  an 
examination  into  the  subject.  Without  a  knowledge 
of  the  remote  cause  of  a  pestilence,  no  well  ordered 
measures  can  be  employed  to  exclude  the  misery  it 


28 


ASIATIC  CHOLERA. 


will  carry  into  a  country,  or  measures  to  mitigate  its 
power  for  evil  when  once  it  prevails;  without  such 
knowledge,  every  precaution  taken,  every  means  and 
effort  to  control  it,  will  amount  to  confusion,  great 
errors,  injurious  restrictions,  even  oppression,  while 
all  the  time  the  best  and  most  anxious  intentions  are 
in  full  exercise. 

30.  In  the  early  days  of  Indian  cholera,  practi- 
tioners appear  to  have  vied  against  each  other  which 
should  be  the  most  ardent  argumeutator  in  support 
of  the  assertion  that  the  pest  was  due  to  something 
else  than  contagion. 

There  always  appears  to  be  something  peculiar  in 
the  medical  mind  which  prompts  the  votaries  of  that 
obscure  science  to  seek  elsewhere  for  explanations 
than  among  the  simple,  every-day  facts  that  strike 
the  common  sense  of  the  vulgar.  This  has  ever  been 
the  case  on  the  occurrence  of  every  known  pest,  and 
never  yielded  to  common  sense  and  observation  until 
the  imaginative,  metaphysical  and  argumentative 
practitioner  has  been  forced  to  abandon  his  fine-spun 
hypothesis. 

Let  us  refer  to  a  few  of  the  pests  that  have  afflicted 
mankind,  and  we  shall  find  that  the  same  contentious 
professional  spirit  prevailed  in  every  one  of  them. 

31.  Plague,  as  it  is  emphatically  called,  is  one  ex- 
ample, which,  until  very  lately,  eminent  partisan 


REMOTE  CAUSE. 


29 


men,  but  not  the  vulgar,  attributed  to  climate,  to  ter- 
restrial exhalations,  filth,  etc.  Even  such  men  as 
Baron  Desgenettes,  a  man  of  unquestioned  science, 
but  also  a  man  of  crotchets,  boldly  contended  that 
plague  was  not  contagious;  and,  to  support  his  as- 
sertion, mixed  freely  among  the  French  infected  in 
Egypt;  even  went  so  far  as  to  inoculate  himself  with 
the  matter  of  the  pestilential  bubo;  and  because  he 
escaped,  cited  his  case  as  proof  irrefragable  of  his 
promulgated  opinion.  Several  enthusiastic  young 
French  doctors  imitated  the  example  set  by  their  ad- 
mired chief,  inoculated  themselves,  and  died.  But 
to  the  partisans  of  a  theory  the  infection  of  the 
young  doctors  was  easily  explained  and  denied,  or 
rather,  ignored;  the  partisans,  whose  greatest  merit 
is  adhesion  to  previous  opinions,  boldly  declared 
that  the  disease  of  these  young  enthusiasts  was  due 
to  the  common  unseen  cause — an  epidemic — and  not 
to  the  inoculation.  Many  medical  writers  appealed 
to  the  example  afforded  by  the  conduct  of  the  com- 
mander-in-chief of  the  army  going  among  the  in- 
fected, and  escaping.  It  was  gravely  asserted  that 
he  escaped  because  he  had  no  fear  of  the  disease. 
It  is  well  known  that  Bonaparte,  like  any  other 
g  ^eat  commander,  would  venture  almost  any  thing  to 
preserve  the  confidence  of  his  army,  which,  if  lost,  all 
wag  lost.    This  story  about  /ear  was  one  of  the 


30 


ASIATIC   CHOLERA. 


stalking-horses  much  paraded  during  the  prevalence 
of  cholera  in  Canada  and  in  the  United  States. 

32.  Another  example  of  medical  contention  is  to 
be  found  in  Typhus.  This  fever  arises  sponta- 
neously in  many  places;  and,  when  there  is  only  one 
case,  or  only  a  few,  here  and  there,  it  does  not 
spread.  This  fact  was  the  origin  of  the  name 
Typhoid;  but,  said  the  originators  of  the  new  name, 
it  is  not  typhus,  because  it  does  not  spread — morbus 
contagiosus  non  est !  In  certain  epidemics  of  the  dis- 
ease and  period  of  its  duration,  there  might,  or 
not,  be  a  cutaneous  irruption  of  petechiaB,  vibices, 
maculae,  etc.  Each  of  these  accidents  to  the  disease 
sufficed  to  furnish  to  the  imagination  of  would-be 
profound  observers  several  new  names  to  a  well 
known  and  heretofore  well  described  disorder,  such 
names  as  spotted  fever,  enteric  fever;  to  autopsists, 
the  names  gastro-enteric  phlegmasia,  ulceration  of 
the  agminated  and  solitary  intestinal  glands,  mere 
accidents  to  the  disease;  and  lately  we  have  been 
favored  with  a  newer  name — cerebro-spinal-arach- 
nitisl  But  when  typhus  spread  incontestibly  from 
person  to  person  it  was  said  to  be  infectious,  but  not 
contagious,  a  distinction  that  tickled  the  author  into 
the  belief  that  he  was  a  profound  observer  and  a 
learned  etymologist. 

33,   Small-pox,  another  contagious  disease,  was 


REMOTE   CAUSE. 


31 


)revalence 
ates. 

ition  is  to 
js  sponta- 
9  only  one 

does  not 
the  name 
new  name, 
d — morbus 
of  the  dis- 
might,  or 
ae,  vibices, 
the  disease 
f  would-be 
to  a  well 
)rder,  such 

autopsists, 
leration  of 
ands,  mere 
have  been 
►inal-arach- 
itibly  from 
us,  but  not 
author  into 

ver  and  a 

sease,  was 


long  ignored  as  such,  and  writers  say  that  Syden- 
ham was  not  aware  of  the  fact.  It  was  first  no- 
ticed in  Europe  in  572,  and  in  580  the  Bishop  of 
Avranches,  in  France,  gave  to  it  the  name  Variola, 
a  Latin  word  of  his  own  coining.  It  desolated  Gaul 
and  Italy,  and  in  580  Austregilde,  wife  of  Gomtran, 
King  of  Bourgoigne  died  of  it.  She  was  so  incensed 
that  she  forced  a  promise  from  the  king  that  her  two 
physicians,  Nicholas  and  Donat,  should  be  sacrificed 
on  her  grave  as  a  punishment  for  not  curing  her. 
The  crime  was  perpetrated.  But  variola  had  long 
been  known  in  China.  It  was  spread  through  Eu- 
rope by  the  Saracens  who  overrun  the  country.  In 
Georgia  the  discovery  of  inoculation  was  made,  and 
necessarily  spread  to  Constantinople,  where  the 
famous  Lady  Montague  learned  it,  and,  returning  to 
England,  prevailed  on  the  Princess  of  Wales  to  set  a 
public  example  by  having  her  children  inoculated,  in 
1716.  This  met  with  violent  opposition  by  the  pro- 
fession and  the  clergy.  It  took  a  long  time  to  intro- 
duce it  into  France,  where  one  of  the  first  to  undergo 
it  was  the  daughter  of  the  famous  Montcalm,  in  1764. 
34.  A  negro,  from  St.  Domingo,  brought  variola 
into  the  army  of  Cortez  in  Mexico,  June,  1520, 
where  it  annihilated  whole  villages  and  towns j  the 
dead  were  too  numerous  to  be  buried,  and  the  stench 
they  created  was  so  great  that  the  houses  were  fired 


32 


ASIATIC   CHOLEBA. 


i     t 


and  in  them  the  dead  burned.    For  a  long  time  vari- 
ola, like  cholera,  was  denied  being  contagious. 

35.  Measles  and  scarlatina  were  also  brought  into 
Mexico  about  the  same  time  as  variola.  All  these 
diseases  were  hitherto  unknown  in  America. 

36.  Syphilis  belongs  to  the  above  category,  but 
for  reasons  that  may  be  appreciated  is  passed  over. 
Nor  need  I  refer  to  the  black-death  and  the  Sudor 
Anglicus,  both  of  them  limited  pests. 

The  four  pests  mentioned  are  referred  to  simply  to 
show  that  contagion,  admitted  from  the  first  by  the 
vulgar,  has  been  generally  denied  for  a  while  by  the 
scientific;  and  is  here  introduced  as  a  preparatory 
caution  to  the  reader  before  he  goes  through  the  ex- 
amples cited  in  this  chapter  on  remote  causes, 
wherein  it  will  clearly  appear  that  cholera  never 
preceded,  but  always  followed,  the  arrival  of  infected 
persons. 

37.  If  we  contemplate  with  unbiased  minds  the 
itinerary  of  cholera,  in  India  and  elsewhere,  it  will 
appear  that  the  malady  spread  from  individual  to  in- 
dividual; that  it  nowhere  broke  out  until  communi- 
cation had  taken  place  with  the  affected;  that  it 
never,  in  a  single  instance,  preceded  the  arrival  of 
affected  persons  or  things;  that  it  often  broke  out 
almost  immediately,  and  rarely  later  than  thirty- 
six  hours  after  the  arrival  of  the  infected;  that  it 


4I 


REMOTE  CAtJSE. 


33 


rapidly  attacked  a  fourf  -nore  or  less,  of  the  inhab- 
itants of  a  place  previously  healthy,  and  that  at  least 
one-third  of  the  attacked  died;  that,  in  a  limited 
population,  as  that  of  a  small  town  or  village,  or  a 
concentrated  one,  as  on  ship-board,  it  soon  ex- 
hausted itself,  and  ceased  to  rage  in  two  or  three 
weeks,  or  less  time;  that  when  a  large  town  was  at- 
tacked, it  would  take  from  two  to  three  months  to 
select  all  the  susceptible,  and  then  cease. 

From  these  data  we  are  forced  to  believe  that  the 
remote  cause  is  a  poison  generated  in  a  patient,  and 
emanated  from  his  person.  This  theory  is  sup- 
ported by  the  fact  that  seclusion  invariably  pro- 
tected the  secluded .  We  can  only  suppose  it  to  be 
a  poison  which  travels  independently  of  wind,  cli- 
mate, and  season — a  poison  given  out  by  man,  and 
carried  by  man  to  man.  It  is  of  no  consequence 
what  place  or  person  afforded  the  starting-point — it 
is  individual  in  every  patient  and  place;  its  cause  is 
ONE  and  identical  everywhere.  Tropical  heat  made 
no  difference  in  its  violence  or  duration  from  that  of 
a  Russian  winter;  the  atmosphere  neither  carried 
nor  opposed  its  transmission,  since  it  traversed  the 
broad  ocean  against  the  trade-winds.  Famine  and 
peculiar  food  made  no  diflFerence,  nor  did  races  of 
men,  since  it  broke  out  with  equal  severity  in  the 
palace  of  the  prince,  the  mansion  of  the  nabob  and 


84 


ASIATIC   CHOLERA. 


the  rich  merchant,  and  the  hovel  of  the  peasant  and 
the  poor. 

38.  Why  and  how  this  greatest  of  all  known  pests 
originated  and  spread  with  appalling  rapidity  in  all 
directions  from  the  place  of  its  birth,  regardless  of 
topography  and  seasons,  has  been  largely  commented 
upon,  as  might  be  well  expected.  For  several  years 
after  its  irruption  in  1817,  the  majority  of  opinions 
for  a  while  seem  to  attribute  its  propagation  to 
occult  causes  outside  of  its  victims;  yet  it  is  curious 
to  notice  that  many  "  medical  boards,"  that  were 
appointed  to  report  on  the  "  disease,"  manifested  in 
the  reports  a  strong  bias  in  favor  of  the  opinion  that 
it  was  propagated  by  the  persons  aflfected — curious, 
we  say,  to  find  the  same  names  attached  to  the  official 
reports,  as  are  found  outside  of  the  reports  on  the 
title-page  of  numerous  monographs  written  to  pro- 
mulgate an  opposite  opinion,  that  is,  that  the  disorder 
is  not  communicated — is  not  contagious;  and  these 
opinions  are  supported  by  "facts"  and  much  meta- 
physical reasoning.  It  would  seem  that  the  officer 
charged  with  a  responsible  duty  towards  his  govern- 
ment felt  shy  in  making  a  hazardous  and  dangerous 
declaration,  but  who,  left  to  a  flighty  imagination, 
felt  himself  now  free  from  responsibility  in  his  pri- 
vate writings. 

39.  To  deal  fairly  with  the  non-contagion  theo- 


REM«  -ri   CAV8F- 


u 


lists,  it  is  only  justice  to  sny  that  tl  fsrnlt  of 
Moscow,  who  Icncw  the  disorder  only  iiom  printed 
accounts,  were  all  contagionists;  but  shortly  after 
they  became  personally  observant  of  the  plague,  in 
1830,  soon  changed  from  contagionists  to  non-con- 
tagionists.  This  change  of  opinion  they  openly  pro- 
claimed, and  supported  it  by  writings  in  which  they 
justified  their  new  opinion,  by  stating  that  medical 
officers,  students,  nurses,  etc.,  OHcaped,  although  much 
exposed.  To  superficial  observers  these  "  facts" 
seemed  irrefragable,  and  they  are  oven  now  appealed 
to  by  medical  men  given  to  polemics.  However,  we 
must  again  do  justice  to  the  practitioners  in  Moscow, 
by  recording  that  in  a  few  weeks  they  once  more 
changed  opinion,  seeing  that  the  "  facts"  they  relied 
upon  had  been  erroneously  observed,  and  that  the  sup- 
posed exempt  were  soon  numbered  among  the  vic- 
tims. It  now  became  manifest  that  what  appeared  to 
be  a  fact  yesterday,  ceased  to  remain  a  truth  after 
more  extensive  inquiry. 

40.  This  alleged  impunity  of  exposed  persons  has 
been  from  the  beginning  and  throughout  the  reign  of 
cholera  the  one — the  only — argument  against  the 
idea  of  contagion;  and  was,  and  has  been,  contested 
with  a  partisan  mode  of  argumentation  which  has 
brought  into  strong  relief  the  mental  capacity  of 
some  of  the  writers  for  metaphysical  reasoning,  bril- 


86 


ASIATIC  CHOLERA. 


liant  aH  well  M  confusod  ideas,  and  tenacity  of  pur- 
pose. 

41*  Among  the  assigned  causes  that  originated 
and  perpetuated  the  malady  was  the  atmosphere — 
that  convenient  receptacle  for  the  location  of  all 
kinds  of  medical  ignorance.  Chemical  admixtures, 
physical  admlxturcH,  even  metaphysical  admixtures 
were  declared  to  exist  therein,  and  were  proved  to 
the  satisfaction  of  each  author,  however  widely  they 
might  differ  one  from  the  other.  For  at  least  fifteen 
years  the  medical  press  teemed  with  these  lucubra- 
tions, caught  up  by  the  newspaper  press,  and  made 
clear  "  to  the  meanest  capacity."  But  a  necessary 
condition  for  the  atmospheric  cause  to  operate  was 
some  anchorage  ground  in  the  patient— he  must  be 
"  predisposed'' — he  must  have  taken  cold— -his  system 
must  bo  in  an  "  abnormal''  state — his  digestion  must 
be  disturbed,  etc. 

42.  Numerous  equally  absurd  statements  were  put 
fortli:  atmoHphorical  and  terrestrial  commotions  were 
accompaniments,  or  rather  causes,  of  cholera;  rapid 
change  of  temperature  from  cold  to  heat ;  baromet- 
rical fluctuations,  unwonted  meteors,  whirlwinds) 
waterspoutH,  fogs,  volcanoes  and  earthquakes,  over- 
flow of  riveri,  geological  changes  that  are  continuously 
and  silently  going  on.    Influence  of  comets  (the  one 


REMOTE   CAUSE. 


ST 


Bcon  iti  November,  1831  or  '2),  extraordinary  Lumen 
Zodiacalcy  seen  September  29th,  1829. 

43.  Remarkable  aurora  boreal  is,  7  th  January,  1830, 
and  another  in  August;  a  new  island  uplieaved  in 
the  Mediterranean;  clouds  of  hitherto  unknown  green 
insects  in  the  upper  strata  of  the  atmosphere,  brought 
down  on  the  tails  of  kites  at  Astrachan,  reported 
by  a  learned  naturalist  (nothing  like  leather  to 
fortify  a  city,  said  the  cobbler).  But  Dr.  Forstor 
says:  "  I  give  little  credit  to  this  statement  as  a  cau^r*; 
for  I  ascended,  on  the  30th  April  last,  to  a  hei,^^ 
6,000  feet  in  a  balloon,  and  found  none  of  these 
pestilential  flics  which  some  experimentalists  pretend 
to  have  come  down  on  the  tails  of  kites."  A  tornado 
in  Barbadoes;  earthquakes  in  Venice  and  Parma. 
All  the  authjors  of  the  foregoing  inanities  seem  to 
forget  that  cholera  ravaged  the  world  at  least  thirteen 
years  before  the  occurrence  of  the  foregoing  state- 
ments. One  of  the  casuists  boldly  declares:  "  I  am 
convinced  that  if  a  premium  were  oflfered  for  the 
importation  of  cholera  or  yellow  fever,  by  means  of 
dress  or  bed-clothes  in  which  patients  had  died,  the 
thing  would  be  found  impossible.  No  mischief  would 
arise,  unless  the  importers  of  the  bed-clothes  could 
import  the  'peculiar  constitution  of  the  atmosphere 
and  the  earth  under  the  atmosphere  where  these 
maladies  originate."  What  a  waste  of  time  and  money 
3 


I 


i 

»:8rl 

ri 


■'  '»i 


88 


ASIATIC    CHOLERA. 


to  have  taught  such  a  man  to  write  1  Another  phi- 
losopher says:  "  Specific  local  atmospheres  produced 
by  irregular  streams  of  specific  atoms  from  the  interior 
of  the  earth.  Perturbatcd  electrical  and  magnetical 
states  of  the  air  and  earth  have  been  the  hobby  ridden 
by  many  a  daring  medical  Mazeppa." 

44.  Another  cause  assigned  was  great  humidity  of 
the  air  in  some  places,  over  swamps  and  deltas. 
This  supposed  cause  was  announced  by  practitioners 
who  lived  in  humid  localities,  and  who  heeded  not 
that  cholera  reigned  equally  supreme  in  arid  countries 
— such  as  Arabia,  where  rain  scarcely  ever,  or  never, 
falls,  the  land  parched  to  a  great  depth,  and  a  spring 
of  water  so  great  a  rarity  as  to  be  sought  for  at  a 
distance. 

45.  Others  attributed  it  to  vegetable  and  other 
putrefaction  exhaled  from  low  places;  while  it  is  well 
known  that  such  putrefaction  did  not  and  could  not 
be  a  cause,  since  aridity  was  the  rule  in  some  countries 
where  cholera  prevailed.  Another  statement,  much 
in  vogue  for  a  time  and  widely  disseminated  by  jour- 
nals and  common  newspapers,  was  that  cholera  fol- 
lowed the  "  great  lines  of  commerce."  We  are  left 
to  suppose  that  it  followed  these  lines  as  a  mere 
traveling  companion — never  preceding  commerce  or 
lagging  behind.  The  way  the  wind  blew  did  not 
disturb  the  traveler,  for  he,  cholera,  traveled  in  the 


REMOTE   CAUSE. 


39 


"  wind's  eye"  rather  than  abandon  his  companion, 
commerce;  and  all  this  time  the  atmosphere  "was  the 
abode  of  the  pest  that  moved  in  a  contrary  direction. 
I  well  remember  with  what  dogmatic  assurance  a 
merchant,  newspaper  editor,  or  other  pretender  to 
linowledge,  would  cut  all  statements  short  by  throw- 
ing the  hackneyed  phrase  in  your  face,  "  it  follows 
the  great  lines  of  commerce  '*— reply  to  that,  if  you 
can  I 

46.  While  being  carried,  according  to  some  rca- 
soncrs,  by  the  atmosphere  from  place  to  place,  it 
would  descend  to  attack  victims  in  one  spot  and  spare 
an  adjoining  place,  over  both  of  which  this  atmo- 
sphere spread  equally.  Cholera  would  attack  one 
side  of  a  river,  the  road  side,  and  neglect  the  other; 
attack  the  inmates  of  one  house  and  not  those  of  an 
adjoining  one;  attack  some  portions  of  a  town  and 
not  others,  while  the  same  atmosphere  enveloped  all 
sides  and  over  all  equally. 

The  foregoing  Statements  are  only  a  few  of  the 
many  put  forth  and  bandied  about  for  several  years, 
to  the  disgrace  of  the  human  understanding,  and 
should  not  now  be  noticed  were  it  not  that  there 
still  linger  some  of  those  credulous  or  obstinate  beings 
who  are  an  annoyance  to  the  profession. 

To  descend  from  the  extravagant  and  wild  flights 
of  imagination  like  the  foregoing,  IcL  us  notice  some 


iiii 

1^' 


m 

In: 

I? 


■  I 


t-'-i  '-fr 
1  *!      t 


m-i' 


•  ) 


t  > 


i 


40 


ASIATIC    CHOLERA. 


of  the  more  reasonable  opinions  at  first  put  fortli 
regarding  the  remote  cause,  or  causes,  of  this  dire 
visitation  upon  humanity. 

47.  Moisture  a  remote  cause.  Let  us  examine  this 
alleged  cause.  It  was  natural  enough  for  practitioners 
living  in  the  extensive  flat,  low  ana  swampy  country 
of  the  Bengalese  territory — a  country  intersected  in 
all  directions  by  numerous  dikes,  rivulets  and  rivers, 
tributaries  of  the  great  Ganges,  which  opens  into  the 
sea  through  a  nearly  stagnant  delta  of  many  branches, 
called  the  Sunderbunds — to  attribute  its  malignant 
character  and  origin  to  the  nature  of  such  a  country, 
the  capital  of  which,  Jessore,  low,  flat  and  wet,  like 
the  country  around  for  many  miles.  Besides  this 
disadvantage,  it  is  a  remarkably  ill  kept  and  filthy 
city,  containing  a  dense  population. 

It  is  here  that  cholera  is  alleged  to  have  first  put  on 
the  malignant  and  spreading  form.  To  these  sanitary 
defects  add  the  hot  season,  which  commences  in 
March  under  a  south  wind,  the  temperature  rising  from' 
70^  to  90^.  The  rainy  season  commences  in  June 
and  continues  until  October,  before  which  time  the 
Ganges  reaches  its  highest  point,  and  inundates  the 
country  to  a  vast  extent.  The  cool  season,  which  is 
never  cold,  commences  in  November  and  lasts  until 
February.  During  this  time  the  sky  is  clear,  the  air 
cool  and  bracing,  the  thermometer  ranging  from  45^^ 


REMOTE  CAUSE. 


41 


line  thi3 
titioners 
country 
Dcted  in 
i  rivers, 
into  tho 
ranches, 
ilignant 
jountry, 
ret,  like 
des  this 
id  filthy 

t  put  on 
sanitary 
ices  in 
ng  from 
in  June 
ime  the 
Eites  the 
rhich  is 
ts  until 
the  air 
om  45^ 


to  75**,  with  winds  mostly  from  the  northwest.  But, 
although  it  does  not  rain  in  this  season,  copious  dews 
prevail  at  night,  owing  to  the  great  daily  evaporation 
and  nocturnal  precipitation. 

48.  It  is  not  to  be  wondered  that  the  early  writers 
on  this  pestilence  should  have  attributed  its  iiew  and 
malignant  character  to  such  moisture,  and  to  a  filthy 
city.  Moreover,  in  this  year,  1817,  the  amount  of 
rain  that  fell  was  quite  one-third  more  than  in  former 
year?.  The  inundations  cut  off  communications,  and 
thus  increased  the  scarcity  of  provisions  and  deteri- 
orated the  quality  of  what  remained. 

The  pestilence  soon  spread  to  Calcutta  in  apalling 
force,  among  the  poor  first,  who  are  improvident  and 
intermingle  freely  and  without  discrimination.  It 
soon  after  attacked  the  better  classes  with  equal  viru- 
lence, but  in  less  numbers,  because  they  are  less  nu- 
merous and  more  guarded  in  their  intercourse.  By 
September  the  villages  and  towns  for  several  miles 
around  were  all  infected. 

49,  Now,  as  if  to  baffle  and  joke  with  medical 
opinions  and  statements,  the  following  mdisputable 
facts  occurred:  While  cholera  traveled  northwardly 
from  Calcutta  in  this  same  year,  1817,  between  Agra 
and  Delhi  there  are  many  villages  situated  in  low 
grounds,  but  these  all  escaped,  while  Cawnpore, 
Meerhut,  Agra  and  Delhi,  all  high  and  dry  grounds, 


w 


"  I- 


l» 


pi! 


■\  \  ■ 


\l 


'  j 
'111 

111 


42 


ASIATIC   CHOLERA. 


■  I 
1   ^lil 


i 


suffered  severely.  The  fortress  of  Jaragurth,  1,000 
feet  above  the  plain,  suffered  greatly,  and  this  while 
the  inhabitants  of  towns  at  the  foot  of  the  mountain 
escaped.  These  high  and  great  towns  were  rendez- 
vous of  trade,  the  government  commissariat  and 
troops. 

60.  If  only  low  places,  like  the  deltas  of  the  Gan- 
ges, the  Euphrates  and  the  Nile,  etc.,  had  been  at- 
tacked, ?ion-contagionists  might  say,  with  a  strong 
show  of  probability,  that  cholera  was  due  to  marshy 
miasm.  i 

We  shall  now  proceed  to  show  that  low  grounds, 
swamps  and  deltas  were  no  more  obnoxious  localities 
than  the  high,  dry  and  healthy  parts  of  the  world. 

61.  Dry  grounds  and  high  countries.  The  high 
mountains  which  separate  Hindostan  from  Nepaul 
were  invaded  by  the  pest,  as  well  as  the  elevated 
table  lands  of  Nepaul,  Patum  and  Rhatgoun,  4,000 
feet  above  the  sea.  Catmandou,  on  the  lower  range 
of  the  Himmalaya,  at  a  height  equal  to  the  Pyrennes, 
suffered  greatly.  Surely,  this  is  land  high  enough 
and  cold  enough  to  contrast  with  the  steaming  swamps 
of  the  Sunderbunds  and  that  hot  climate. 

62.  The  table  land  of  Mysore,  Darwar,  Belgaum, 
Bengalore,  all  very  high,  over  4,000  feet  above  the 
sea,  were  attacked  with  equal  fury  and  destruction  to 
lower  and  hotter  places. 


REMOTE   CAUSE. 


43 


Cholera  crossed  the  Ghaut  mountains  Viat  separate 
the  east  of  India  from  the  coast  of  Malabar,  a  moun- 
tain range  as  high  as  the  Carpathians  or  the  Pyre- 
nees in  Europe.  It  invaded  the  town  of  Candy,  situ- 
ated at  a  great  height,  in  the  island  of  Ceylon,  as 
early  as  December,  1818,  having  commenced  at  the 
coast  and  spread  to  the  interior. 

It  ravaged  the  Pachalicks  of  Syria,  and  crept  up  the 
flanks  and  over  the  top  of  Mount  Lebanon,  in  1823; 
attacked  the  town  of  Tiberias  in  the  winter  of  1824; 
ravaged  the  Caucasus,  the  flanks  of  Ararat,  tiie  Him- 
malayas,  where  its  violence  and  destruction  were  equal 
to  what  happened  in  low  and  hot  places.  Nor  did 
the  valley  of  the  Jordan  escape,  a  country  1 ,400  feet 
above  the  sea. 

53.  Cold.  Besides  the  elevated  countries  just 
named,  which  are  naturally  of  low  temperature,  spe- 
cial mention  may  be  made  of  the  invasion  of  cholera 
in  the  north  of  Europe,  where  the  country  is  liat,  but 
not  wet  in  the  winter  time,  since  all  surface  water  is 
frozen  over.  The  pest  reached  Moscow  in  October, 
and  persisted  there  until  its  decline  at  the  end  of  De- 
cember, 1830,  a  period  of  nearly  three  months,  quite 
as  long  as  it  lasted  in  any  invaded  hot  place — appar- 
ently the  allotted  period  of  its  duration  and  power  in 
every  place  it  has  invaded.  From  Moscow  it  traveled 
north  to  Yarosof,  and,  turning  to  the  west,  reached 


II' 

Hi 
%\ 

R 
If  1 

¥' 


1  !. 


m 


I        41 


.* 


ir! 


I; 


!    : 


44 


ASIATIC   CHOLERA. 


Rybinsk,  sixty  leagues  north  of  Moscow,  on  the  road 
to  St.  Petersburgh,  on  the  19th  March,  1831.  This 
calendar  of  its  march  shows  that  the  severe  frost  of 
an  intensely  cold  country  did  not  arrest  it  or  alter 
the  quality  of  the  pestilence. 

It  is  now  evident  that  neither  low  nor  high  lo- 
calities, nor  warm  nor  cold  regions  made  any,  the 
slightest  difference,  in  the  spread  of  cholera,  its 
severity  or  its  nature. 

64.  Geological  formation.  Cholera  swept  the  sur- 
face of  the  Arabian  deserts,  a  country  so  dry  that 
showers  are  unknown,  and  where  a  spring  of  water 
is  the  object  of  a  journey  of  300  miles.  It  desolated 
the  dry  calcareous  plains  of  Arabia  with  the  same  fury 
as  the  deltas  o^  the  Ganges,  the  Euphrates  and  the 
Nile,  the  swamps  of  the  Volga  and  Dnieper;  trav- 
ersed with  equal  ease  the  sandy  plains  of  the  Yemen, 
the  basaltic  declivities  of  Mauritius  and  Bourbon. 

65.  Communication  from  plaxie  to  place,  and  from 
person  to  person.  In  this  section  we  shall  notice 
only  the  best  authenticated  statements,  without  fol- 
lowing, seriatim^  the  propagation  from  Jessore, 
whence  cholera  ascended  the  Ganges,  attacking 
place  after  place,  each  having  previously  given  pas- 
sage to  infected  pereons,  until  it  reached  the  healthy 
banks  of  the  Sinde,  attacking  first  the  numerous  fol- 
lowers of  the  army  of  the  Marquis  of  Hastings  on 


REMOTE  CAUSE. 


45 


the  6th  of  November.  By  the  15th,  in  nine  days,  it 
spread  throughout  the  camp,  attacking  all  ages  and 
sexes.  In  five  days'  time  5,000  deaths  took  place — 
one  thousand  a  day  1  In  this  short  space  of  time  it 
had  reached  its  acme;  then  commenced  to  decline 
until  the  23d,  barely  two  weeks,  when  few  casei  oc- 
curred, and  the  deaths  that  now  happened  were 
those  cases  that  had  lingered  on  for  several  days, 

66.  The  Marquis,  now  that  the  storm  was  over, 
commenced  to  move  his  camp  to  the  southeast,  and 
did  not  complete  the  march  until  the  19th  December, 
a  period  of  26  days.  During  this  march,  very  few 
cases  broke  out,  and  none  after  the  8th  of  December. 
On  the  foregoing,  Mr.  Kennedy  lucidly  remarks: 

"  A  superficial  acquaintance  with  the  progress  of 
cholera  might  lead  to  the  supposition  that  its  de- 
cline was  connected  with  the  change  of  locality  pre- 
scribed by  the  commander-in-chief;  but  the  history  of 
the  disease  shows,  on  the  contrary,  that  it  had  run 
its  course  of  infection  before  the  army  quitted  tlie 
banks  of  the  Sinde,  and  the  only  benefit  derived 
from  the  change  of  air  was  the  assistance  it  aflforded 
in  the  recovery  of  the  multitude  of  people  who  lin- 
gered under  the  effects  of  an  old  attack.  To  ascribe 
the  cessation  of  the  pestilence  to  any  virtue  in  the 
soil  or  atmosphere  of  the  encampment  by  the  Betwah 
would  be  little  less  than  abiunl;  for  the^  troops  did 
3* 


III 


11 


••  t 


i 


»     ' 


1 


1 1 


!   I 


46 


ASIATIC   CHOLERA. 


not  arrive  there  until  the  19th  December,  and  a  now 
case  of  cholera  had  not  been  observed  during  the 
eleven  days  which  immediately  preceded  their  ar- 
rival. If  additional  evidence  were  really  necessary 
to  settle  this  point,  it  would  bo  amply  furnished  in 
the  laio  of  increase  and  decline  appertiiining  to  chol- 
era. This  law  informs  us  that  when  the  malady  has 
been  developed  in  a  camp  it  will  continue  its  ravages 
through  the  period  of  one  month  or  so,  independent 
of  locality — whether  the  infected  camp  be  removed 
from  a  moist  to  a  dry  district,  or  from  a  low  to  an 
elevated  station — and,  at  the  expiration  of  the 
month,  that  the  disease  will  die  away  sponta- 
neously." 

Staff-Surgeon  Connell  reported,  Secunderabad, 
May  20th,  1819:  **  A  detachment  of  Europeans, 
under  Major  Wahab,  arrived  here  with  the  cholera 
among  them.  The  disease  first  attacked  these  troops 
at  the  Kistnah,  after  exposure  to  a  great  storm,  and 
it  continued  with  them  to  this  place,  although  all  the 
villages  in  their  route  were  entirely  free  from  the 
disorder.  During  the  march  sixty  individuals  per- 
ished, of  whom  eight  were  Europeans.  On  its  ar- 
rival here,  the  detachment  encamped  about  two 
hundred  yards  in  front  of  our  artillery  lines.  In 
this  new  situation,  three  Europeans  and  a  number  of 
natives  died.     Up  to  this  time  no  case  had  occurred 


REMOTE   CAUSE. 


47 


in  the  encampment.  The  Europeans,  however,  of 
Klijot  Wahab's  detachment  mingled  with  our  party 
of  artillery,  and  in  the  course  of  four  or  five  days 
the  disease  began  among  the  latter.  ***** 
*  *  My  sub-assistant,  Mr.  Hoskins,  who  was 
constantly  with  the  sick,  took  the  disease  and  died 
in  twenty-four  hours.  Another  sub-assistant,  Mr. 
Steven,  and  Mr.  Assistant-Surgeon  McDougal  were 
attacked.  The  disease  traveled  to  the  bazaars  and 
carried  oflf  many  of  the  natives.  The  men  of  the 
Thirtieth  regiment,  who  were  in  barracks,  half  a 
mile  to  the  right,  completely  escaped. 

*'  I  beg  to  add  that  Mr.  Jones,  Surgeon  of  the  6th 
Light  Cavalry,  has  just  arrived  from  Kistnah,  by  the 
same  route  as  Major  Wahab.  .  Mr.  Jones  states 
that  he  found  the  cholera  prevailing  in  every  village, 
having  commenced  soon  after  the  passage  of  Major 
Wahab's  men.  The  inhabitants  said  they  had  got  it 
from  that  detachment." 

57.  After  the  irruption  of  1824,  Madras  remained 
free  and  healthy  until  March,  1827,  three  whole  years. 
But  in  July  it  suddenly  broke  oat  with  violence  at 
Jaulnf*.,  Hyderabad,  etc.;  during  this  irruption,  the 
governor  of  Madras,  Sir  Thomas  Munro,  died.  He 
sat  down  to  breakfast  at  Pullycondah,  a  village 
twenty  miles  from  Gooty.  While  at  breakfast  he 
was  taken  with  the  first  symptoms,  and  said  to  his 


n 


si 

n 


h 


•  ■■ 


{  I 


'  1 


48 


ASIATIC   CHOLERA. 


secretary,  who  was  beside  him,  ^^Get  atoay;  lam  an 
infected  man"  and  he  died  ten  hours  after. 

58.  The  pest  reached  Suedie,  Mediterranean  coast 
of  Africa.  But  it  was  not  very  dest  active  here. 
However,  Mr.  Baker,  British  consul,  reported  that 
he  had  about  twenty  natives  at  work  harvesting  for 
him,  all  robust  and  healthy  men.  On  the  9th  July, 
at  noon,  when  all  appeared  well,  one  was  suddenly 
attacked,  and  shortly  after  others,  with  vomiting  and 
cramps.  Some  died  in  three  hours,  others  at  sun« 
down,  and  all  were  dead  before  daylight.  At  this 
time  strong  westerly  winds  prevailed,  which  extended 
one  hundred  miles  into  the  country,  but  did  not  drive 
the  pest  back  to  the  east,  whence  it  came.  "  li  had 
traveled  in  the  loind's  eye." 

69.  A  detachment  of  troops  brought  a  state  pris- 
oner from  Panwell,  where  cholera  raged,  eighteen 
miles  from  Bombay,  to  Tannah  in  the  island  of  Sal- 
sette,  where  it  at  once  broke  out.  Thence  it  spread 
from  village  to  village;  but  several  villages,  which 
had  no  intercourse  with  the  infected  places,  escaped; 
however,  after  several  months'  immunity,  they,  too, 
were  attacked  through  a  renewal  of  intercourse. 

60.  Cholera  broke  out  in  the  Thirty-fourth  regi- 
ment on  its  march  from  Bellary  to  Bengalore.  All 
the  villages  on  the  route  were  healthy;  but  imme- 
diately after  all  the  villages  it  passed  through  became 


REMOTEI  CAUSfi. 


49 


affected.  A  native  soldier,  traveling  from  Bengalore 
to  Nundedroog,  both  places  then  healthy,  passed 
through  the  Thirty-fourth,  w.is  attacked  and  died. 
Nagpore  suffered  in  May.  A  brigade  in  perfect 
health  arrived  at  Nagpore,  now  an  infected  place,  on 
the  4th;  on  the  6th  the  malady  broke  out  among  the 
men  with  great  mortality.  The  English  army,  in  the 
best  of  health,  encamped  at  Torayt,  and  received  a 
detachment  which  had  boon  attacked  at  the  pa33agc 
of  the  Jumna.  Immediately  after  the  junction  the 
malady  appeared  in  camp.  A  company  which  had 
lost  some  men  on  its  march  arrived  at  Trichinopoly, 
then  quite  healthy;  the  pe:§t  immediately  broke  out 
among  the  people  and  spread  to  the  environs.  The 
Fifteenth  native  regiment,  affected  with  cholera, 
marched  on  Gooty;  the  villages  through  which  it 
passed  immediately  became  infected  and  desolated  by 
this  scourge,  from  which  the  inhabitants  had  ever 
before  been  exempt. 

01.  Muscat,  a  seaport  at  the  extremity  o^  the 
Arabian  peninsula,  much  frequented  by  traflBc  from 
Bombay,  where  cholera  prevailed,  became  infected 
in  July,  1821.  About  the  same  time  the  islands  of 
Ormus  and  Kishm^,  at  the  mouth  of  the  Persian  Gulf, 
became  infected  by  trading  vessels.  Bender  Abassi 
sunk  beneath  its  rage,  and  in  a  short  time  one-sixth  of 
the  inhabitants  perished;  the  bazaars  were  closed,  the 


i 


i!;; 


.    .. 


Iff' 


50 


AMfATIC  CHOLERA. 


houses  abandoriod,  unburiod  dead  lay  in  heaps  in  the 
streets,  the  Murvlviiig  population  having  fled. 

03.    Polaml  ami  (ioiklng.     After   the  battle  of 
3l8tMarch,  IH'U,  In  which  the  Poles  were  victorious, 
they  encatripjul  In  a  morass,  and  remained  there  eight 
days.     April   lOth  a  part  of  this  division  fought 
before  Siodluo   with   the  corps    of    Count  Phalen, 
which  waH    InfocUjd  with  cholera.      On  the   13th, 
while  passing  through  Kuflcw,  a  report  was  received 
that  aix  men  hud  <llod  of  cholera  after  a  few  hours' 
illness.    ThflHO  niou  forni'^d  part  of  the  first  brigade, 
which  had  captured  colors  and  several  prisoners. 
Arriving  near  Mlnnk  tho  ca^os  became  more  numerous, 
and  on  t!io  I5th  fifty  had  died.    The  majority  of  the 
patients  had  on  them,  dotldng  taken  from  the  sick 
enemy.     Tlio  «ocond  brigade,  which  had  not   been 
engaged  at  Hicdlce,  had  no  cholera  for  a  length  of 
time.    Later,  another  division,  in  a  state  of  perfect 
health,  encanipod  near  Kuflew,  on  the  ground  where 
the  Russians  had  ju/^t  been  defeated;  several  bodies 
still  lay   oxposol,  others  only  half  buried.     Here 
cholera  broke  out  anew  among  the  Poles.     Towards 
the  end  of  May  the  division  had  a  serious  engage- 
ment at  Tycouln,  and  cholera  broke  out  among  the 
Poles  for  a  thirO>  time. 

63.  About   200   tailors  took   as  assistints  from 
among  the  Ruiijlan  prisoners,  som3  of  them  to  work. 


j^a^t'rr 


REMOTE  CAUSE. 


51 


Cholera  tmm'iUatehj  broke  out  among  the  former. 
Russian  prisoners  were  dispersed  over  several  vil- 
lages and  towns,  and  wherever  they  went  cliolera 
coincided  with  their  arrival. 

61.  The  last  great  battle  fought  by  Count  Die- 
bitsch  was  on  the  26th  of  May,  and  the  result  was 
equivocal.  Diebitsch  to;)k  ill  success  to  heart,  was 
seized  with  cholera,  at  Pultask,  on  t'le  10th  of  June, 
and  in  a  few  hours  died.  Also,  on  tlio  27t!i  of  the 
same  month,  the  Grand  Duke  Constantino  died,  at 
Witepsk,  of  cholera. 

65.  Nijne-Xovgorod,  in  the  centre  of  Russia,  was 
attacked  27th  of  August,  immediately  after  t'.ie  great 
annual  fair,  when  100,000  merchants  had  assembled 
to  purchase  the  s'lawls  and  furs  t!iat  came  from 
Orenburg,  where  these  goods  were  stored  over  the 
previous  winter,  an  infected  place.  But  other 
writers  say  that  cholera  might  have  been  brought 
by  travelers  from  Saratof,  where  cholera  raged  fif- 
teen days  before  the  fair.  Both  accounts  are  likely 
to  be  true. 

68.  Enclosed  /  \ic3S  es3aped.  The  great  city  of 
Gourruckpoor  and  environs  lost  30,000;  but  not  one 
of  the  prisoners  confined  in  the  jails  of  the  city 
was  attacked.  The  frigat3  Topaz,  from  Calcutta, 
anchored  in  the  port  of  St.  Louis,  Mauritius,  Novem- 
ber, 1819,  and  had  lost  men  and  officers  on  the  pas- 


iu.t 


M.j 


"•ij 


Hi 


inl 


52 


ASIATIC  CHOLERA. 


•-'■  / 


Bage,  but  all  were  well  on  arrival  at  St.  Louis.  The 
haughty  captain  refused  to  obey  the  quarantine;  he 
and  his  men  went  on  shore,  and  soon  after  the  pest 
broke  out  and  spread  rapidly — many  were  attacked 
while  walking  the  streets,  and  died  there  almost  as 
soon  as  attacked,  so  severe  were  the  cases;  10,000 
are  said  to  have  perished;  but  the  governor  reported 
that  the  deaths  did  not  exceed  7,000  or  8,000.  Cer- 
tain habitations  that  interdicted  all  communication 
completely  escaped. 

67.  The  neighboring  islatid,  Bourbon,  in  fearful 
proximity  with  Mauritius,  became  alarmed,  and  the 
governor.  Baron  Melius,  at  once  established  a  laza- 
retto, lest  it  might  be  needed,  and  interdicted  all 
communication  from  outside.  This  was  effectual  for 
a  while;  all  escaped,  until  a  smuggling  vessel,  the 
Pic-Var,  clandestinely  landed  some  runaway  negroes, 
December  14th,  at  St.  Denis,  where  the  pest  at  once' 
broke  out.  The  governor  immediately  established  a 
military  cordon  around  the  city,  suffered  no  one  to 
go  out  or  go  in.  The  attacked  were  sent  to  the 
lazaretto,  which  was  also  surrounded  by  military. 
By  these  means  the  country  was  saved  from  the 
spread  of  the  pestilence.  The  contrast  between  the 
two  islands  was  striking:  Mauritius  had  2i  1,000  cases, 
half  of  which  died ;  Bourbon  had  only  259  cases, 
and  178  deaths. 


REMOTE  CAUSTl. 


58 


Dr.  Labrousse  traced  the  infection  step  by  step  from 
the  place  where  the  Pic-Var  landed  the  smuggled 
negroes  into  Bourbon  first  into  two  cottages,  in 
one  of  which  six  negroes  were  attacked,  and  two  in 
the  other.  The  inhabitants,  frightened,  interdicted 
these  places,  and  here  the  pest  was  arrested.  At  one 
of  these  houses,  a  negresse,  Mam^d6,  wife  of  a  fisher- 
man, infected  her  husband,  and  he  died.  She  went  to 
the  residence  of  her  master,  a  mile  off;  the  next  day 
she  was  attacked,  and  communicated  the  pest  to  a 
servant  slave.  The  jail  prisoners  employed  to  con- 
vey the  cases  to  the  lazeretto  died  in  the  service, 
and  only  two  nurses  escaped.  In  the  hospital  the 
pest  attacked  not  only  the  servants,  but  patients 
laboring  already  under  other  diseases.  The  doctor 
exclaims: "  If  this  be  not  contagion,  how  comes  it  that 
a  few  sentinels  effectually  opposed  its  efforts  to  cross 
the  military  cordon  ?" 

68.  When  cholera  ascended  the  Volga  the  Mora- 
vian inhabitants  of  Serepta  shut  the  gates  and  har- 
bors, suspended  all  communications  with  persons  and 
things  from  outside,  and  thus  excluded  the  pest  and 
escaped. 

69.  In  Moscow  cholera  was  arrested  by  seques- 
tering houses  where  it  existed. 

70.  In  1822  Mons.  de  Lesseps,  French  consul  at 
Aleppo,  fearful  of  the  approach  of  cholera,  shut  him- 


Ir. 

> 

i 

I 

i 

i 


■'  1 1 


54 


ASIATIC    CHOLERA. 


self  up  and  his  people,  to  the  number  of  200  persons, 
in  a  large  garden  not  far  from  the  city.  The  garden 
was  surrounded  by  a  wide  fosse  and  a  stone  wall, 
with  a  gate  at  each  end,  which  he  kept  guarded,  and 
prevented  egress  and  ingress.  Not  one  person  in 
this  enclosed  colony  took  the  malady,  while  4,000 
died  in  the  city  in  eighteon  days. 

71.  In  November,  1819,  cholera  attacked  Sankerre- 
droog,  and  reigned  there  until  the  14th  December. 
But  the  mountaingers  forbid  any  communication 
through  the  passes  into  the  valley,  by  which  precau- 
tion the  pest  was  excluded  and  the  inhabitaia;  t  caped 
its  tyranny. 

72.  The  Pacha  of  Egypt  adopted  severe  measures 
in  July,  1824,  and  by  them  the  disorder  1  .it  pre- 
vailed in  Syria  was  prevented  from  entering  the 
valley  of  the  Nile.  This  example,  with  that  of  the 
Shah  of  Persia  at  Teheran,  proves,  among  many 
others,  that  the  contagion  can  be  arrested  by  exclu- 
sion. But  at  last,  in  1830,  news  reached  the  pacha 
that  a  column  of  fugitive  pilgrims  had  already  passed 
Suez,  and  a  second  column  had  proceeded  beyond 
Coffeir,  the  only  points  of  communication  with  his 
dominions.  Instant  orders  were  sent  to  enforce 
quarantine  in  these  places;  but  the  early  travelers 
had  already  passed,  and  by  the  13th  July  4,000  had 
arrived  at  Cairo.     Cholera  broke  out  first  at  Suez, 


REMOTE   CAUSE. 


55 


then  at  Coflfeir,  shortly  after  the  arrival  of  the  fugi- 
tives. Cairo  next  suffered.  The  physicians  and 
apothecaries  died;  the  board  of  health  abandoned 
their  useless  efforts;  people  fled  the  city,  and  those 
who  remained  shut  themselves  up,  and  all  these 
escaped. 

73.  Caravans,  infected,  traversing  from  the  south 
to  the  north,  when  nearing  Teheran,  the  residence  of 
the  shah,  alarmed  him.  He  at  once  issued  orders 
that  the  caravan  should  not  approach  the  town.  In 
consequence  of  this  mandate,  the  caravan  made  a  long 
detour,  infecting  as  they  went  the  places  they  passed 
through,  but  the  city  escaped  by  this  precaution. 

74.  Ships.    Thje  frigate  Leander  anchored,  August, 
1820,  in  the  port  of  Pondichery,  where  cholera  raged. 
She  soon  became  infected  and  put  to  sea  to  escape. 
On  her  voyage  she  lost  ten  men  and  two  oflScers, 
before  she  reached  the  port  of  Trinchimalee,  on  the 
11th  July,  where  no  disease  existed.    Soon  after  her 
arrival  cholera  broke  out  among  the  persons  and 
officials  that  communicated  with  the  ship.    The  sur- 
geon of  the  Marine  Hospital  was  the  first  victim.    It 
soon  spread  through  and  through  the  island,  pre- 
viously healthy.     By  coasting  vessels  it  was  carried 
across  the  strait  into  Colombo,  January  10th,  1819. 

75.  A  brig  carried  it  to  Astrachan,  and  by  boats 
it  reached  the  Sea  of  Azof,  Sebastopol,  etc.    All  the 


% 


?   Is 


V'! 


u 


m 

Hi 


56 


ASIATIC   CHOLERA. 


fishing  villages  on  the  Arabian  and  Persian  shores  of 
the  gulf  escaped,  while  the  great  ship  harbors  and 
entrepots  of  commerce  became  immediately  infected 
after  the  arrival  of  vessels  from  Bombay, 

76.  The  frigate  Abercrombie  left  Bombay  August 
10th,  1828,  a  diseased  place,  in  splendid  condition  and 
fine  weather.  The  same  day  cholera  broke  out  on 
board.  On  the  12th  the  pest  was  general  throughout 
the  ship.     Many  men  died  in  six  hours. 

77.  At  Collapore  the  following  occurrence  is  said 
to  have  taken  place,  no  doubt  much  exaggerated. 
Sixty  persons  embarked  Ko  cross  to  the  opposite  shore, 
and  only  three  were  able  to  disembark,  all  the  rest 
perished. 

78.  The  French  frigates  Cybfele  and  Cl^opatre — 
the  first  put  into  Malacca  and  took  in  supplies  for  the 
crew  on  the  14th.  On  the  1 8th  she  put  to  sea.  The 
fourth  day  out  the  disorder  broke  out  on  board,  and 
resisted  medical  treatment.  On  the  22d  January, 
1822,  the  Cli^opatre  anchored  in  the  roads  of  Manilla, 
where  cholera  existed  fearfully.  On  the  30th  the 
disorder  broke  out  on  board  so  severely  that  the  cap- 
tain departed  for  Macao,  and  in  eight  days  after  no 
new  cases  occurred. 

79.  Extreme  cleanliness  and  hygiene  made  no  differ- 
ence as  a  preventive  or  a  mitigative  of  the  pestilence, 
notwithstanding  the  clamor  of  ignorant  busy-bodies 


i(> 


REMOTE  CAUSE. 


57 


and  meddlesome  newspapers.  Attend  to  these  facts. 
In  September,  1821,  Shiraz  became  infected  by  com- 
merce from  Bender  Abassi.  The  harem  of  the  prince* 
royal  of  Persia  was  almost  the  first  arena  of  its  fury. 
One  of  the  first  to  succumb  was  one  of  his  wives,  besides 
several  of  the  beauties  ir  the  seraglio,  and  some  of 
his  children.  The  palace  of  an  Eastern  prince  is  the 
embodiment  of  all  the  luxury  and  refinement  that  is 
in  the  power  of  man  to  acquire;  grandeur,  elegance 
and  riches  are  the  necessary  accompaniments  of  the 
establishment;  want,  in  the  slightest  degree,  is  un* 
known,  and  suffering,  if  any,  can  only  rarely  be  felt, 
and  that  by  the  few  ladies  therein  whose  organization 
or  moral  sense  may  possibly  here  and  there  revolt  at 
tlieii*  servitude.  Religion  also  comes  in  as  a  portion 
of  the  discipline,  hygiene,  and  extravagance  of  the 
place;  and,  in  this  instance,  is  principally  confined  to 
frequent  ablutions,  extreme  cleanliness,  and  a  feW 
easy  prayers.  The  dresses  are  of  the  most  costly  and 
exquisite  qualities,  changed  several  times  a  day.  To 
these  habits  all  the  attendants  are  scrupulously  ob- 
servant. If  here,  where  cleanlines  and  the  most  per- 
fect system  of  hygiene  that  can  be  sought  for  exists, 
and  still  cholera  invades  such  an  abode,  and  rages  as 
fearfully  as  among  the  most  abject,  poverty  stricken 
and  uncleanly  people,  why  rail  out  against  dirty 
streets  as  a  cause^  and  neglect  more  important  and 


U 


I 


! 


■: 


l-l] 


111 


68 


ASIATIC   CHOLERA. 


serious  matters?  The  palaces  and  families  of  the  In- 
dian princes,  as  at  Delhi,  etc.,  etc.,  escaped  no  more 
than  the  villages,  unless  it  was  due  to  exdusion. 

80,  Religion  as  a  prophylactic  and  a  cure.  Priests 
make  a  religion,  indoctrinate  the  ignorant  into  a  be- 
lief that  they  are  the  elect  and  preferred  of  the  Deity 
to  all  outside  of  their  fanaticism.  This  is  the  moral 
history  of  man,-and  flourishes  in  India. 

In  1818  the  usual  multitude  of  believers  assembled 
at  the  festival  of  Jatra,  in  Punderpore.  In  a  few 
days  three  thousand  fell  victims  to  both  their  faith 
and  the  cholera.  These  pilgrims,  terrified  at  the  pest, 
fled  to  their  homes,  in  spite  of  their  faith  and  the 
power  of  the  priests;  and  wherever  they  went,  there 
cholera  broke  out. 

81.  Eastern  superstition  (religion  of  priests),  in  its 
severe  and  unrelenting  precepts,  scoffed  at  the  power 
of  cholera.  The  votaries,  in  obedience  to  the  pre- 
cepts, assembled  one  hundred  and  twenty  thousand 
to  honor  the  shrine  of  Juggernaut — under  the  wheels 
of  the  car  of  the  idol  the  most  faithful  annually  took 
pleasure  to  prostrate  themselves  and  be  crushed  to 
death — were  waiting  for  the  awful  presence;  but  be- 
fore the  priests  could  wheel  it  out  of  the  temple  and 
commence  the  sacred  ceremonies,  cholera,  in  contempt 
of  the  omnipotent  symbol,  broke  out  among  the  mul- 
titude, of  which  many  thousands  perished.    The  idol 


E-^MOTE  CAUSB. 


59 


remained  in  the  temple  incarcerated  for  several  years — 
perhaps  dared  not  to  face  the  pestilence  1  The  vota- 
ries fled  to  their  homes,  undefended  by  an  ungrateful 
deity,  and  spread  the  infection  in  their  homes. 

82.  When  in  June,  1827,  the  pest  mena  ed  Lahore, 
the  people  sought  to  arrest  it  by  acts  of  devotion  and 
charity.  But  Rungheet  Sing,  the  Maraja,  preferred 
to  absent  himself.  He  crossed  the  river  Rari  and 
encamped  by  the  Kuttel-Khan  gardens.  By  this 
course  he  preserved  himself  and  his  followers. 

83.  In  1820  the  King  of  Siam,  alarmed  by  the 
irruption  of  cholera  in  his  capital,  convoked  his  sub- 
jects on  the  sea-shore,  there,  by  religious  ceremonies, 
to  anathematize  the  disease.  The  result  was  appal- 
ling: seven  thousand  persons  perished  on  the  spot, 
and,  with  the  arrival  of  fugitives  into  all  the  districts 
of  the  kingdom,  cholera  also  appeared  among  the  in- 
habitants. Forty  thousand  died  in  the  capital, 
Bankok.  .  Cholera  treated  the  religion  of  the  priests 
and  the  faithful  v/ith  utter  contempt. 

8i.  In  the  latter  days  of  Chawl  and  the  first  of 
Zilcade  (second  week  in  May,  1831),  thepilgrims  ar- 
rived from  Persia,  the  Indies,  the  Yemen,  and  other 
countries,  suflFering  from  the  pest  at  the  time  of  their 
departure.  Crowded  together,  at  Mecca,  under 
every  circumstance  which  could  favor  the  propaga- 
tion of  the  malady — exposed  to  a  broiling  tempera- 


i 
*  1 


•  -^ 


■    : 
•    :  : 

'■■   i  ' 


i 


60 


ASIATIC  CHOLEBA. 


tare,  wallowing  in  the  putrefying  heaps  of  blood  and 
oflfal  of  victims  sacrificed  at  the  feast  Coram  Bairam 
• — in  four  days  20,000  individuals  perished.* 

Many  more  instances  might  be  cited,  but  the 
above  arc  sufficiently  disgusting. 

85.  Range  of  Infection.  In  no  case  has  the  range 
of  infection  exceeded  a  few  yards'  distance,  especially 
when  the  number  of  attacked  is  few,  or  the  place  is 
airy  or  windy,  which  blows  the  poison  away  into  a 
dilution  insufficiently  concentrated  to  poison  the  un- 
affected. Cholera  commenced  in  the  eastern  wing 
of  the  barracks,  and  proceeded  therein  westwardly 
through  eight  companies  of  the  Fourteenth  regiment; 
but  it  suddenly  stopped  at  the  ninth  company,  and 
the  tenth  or  light  infantry  company  escaped  with  a 

*  Wallovsing  in  putrefying  heaps  of  blood  and  offal.  This  remark 
I  suffered  to  be  transcribed,  that  I  might  not  alter  the  statement 
quoted — not  that  such  putrefaction  could  engender  or  make 
cholera  Avorse  than  if  such  filth  did  not  exist.  It  has  been  abun> 
dantly  proved  by  Bancroft,  Parent  du  Chatelet,  in  thsir  report 
to  the  Paris  Council  of  Public  Health,  that  workers  in  putrefying 
animal  matters  did  not  suffer  from  their  disgusting  trade.  Tho 
butchers,  glue-makers,  catgut-string  makers,  knackers,  anatomi* 
cal  dissecting-rooms,  etc.,  were  not  injurious.  Orfila  stated  that 
the  exhumed  bodies,  in  a  putrid  state,  kept  several  days  under 
judicial  examination,  etc. ,  never  once  disturbed  the  health  of  the 
operators.  But  a  popular  cry  has  been  raised  against  dirt;  of 
course,  let  it  be  suppressed,  but  not  under  a  false  accusation. 


REMOTE   CAUSE. 


ft 


few  cases  only.  There  are  many  such  eycnts  men- 
tioned as  inexplicable;  but  it  soon  became  known 
that  all  the  time  a  strong  westerly  wind  blew 
through  the  barrack,  which  was  open  and  well  venti- 
lated at  the  entrance  end,  to  which  end  cholera  did 
not  reach;  besides,  a  few  yards'  distance  of  separa- 
tion is  abundantly  proved  to  be  a  sufficient  guaranty 
when  communications  are  excluded,  or  at  least  well 
regulated. 

86.  Length  of  time  from  exposure  to  the  break-otd 
of  the  infection  is  variable  within  a  certain  limit.  It 
has  Eeldom  poisoned  its  victim  in  less  than  .twelve 
hours  after  exposure;  most  commonly  twenty-four 
to  forty-eight  hours,  and  rarely  to  the  fourth  day; 
but  in  the  case  of  the  French  frigate  Cyb^le  (§78), 
four  to  five  days  intervened  between  the  exposure 
and  the  irruption. 

87.  Duration  of  the  pestilence  in  each  place.  In 
a  large  and  populous  city,  then,  it  would  last  from 
six  to  ten  weeks,  rarely  to  three  months;  among 
small  communities  and  villages,  it  will  have  selected 
all  its  victims  in  a  space  of  ten  to  fifteen  days.  This 
is  easily  explained  ;  for  the  free  communication  of 
the  inhabitants  of  a  small  place,  all  known  to  each 
other,  they  soon  have  effected  their  intercourse  with 
each  other,  while  a  much  longer  time  must  elapse 
in   a   large  community  before  all   can  have  com- 


1/  I 


.1 ' 


ASIATIC   CHOLERA. 

mingled    who    aro    susceptible   of    receiving     the 
poison. 

88.  This  is  particularly  remarkable  on  ship-board 
— a  small,  compact  population.  A  ship  puts  to  sea, 
apparently  all  well;  in  twenty-four  hours,  or  a  little 
over,  one  or  two  are  attacked;  by  the  third  day 
nearly  all  the  susceptible  are  down  with  the  malady, 
and  in  a  week  more  scarcely  a  new  case  happens. 
The  dead  are  committed  to  the  sea,  and  all  hands  re- 
main well  for  the  remainder  of  the  voyage,  from  four 
to  six  or  eight  weeks.  But  what  happens  after  en- 
tering port?  In  twenty-four  to  forty-eight  hours 
after,  persons  having  intercourse  with  the  passengers 
or  vessel  are  attacked — even  passengers  who  had 
escaped  the  first  onset  of  the  malady,  now  that  they 
get  into  a  new  and  healthy  atmosphere,  are  attacked 
and  die.  This  fact  has  been  frequently  noticed  in 
Canada,  where  persons,  after  remaining  many  days 
in  an  infected  city,  have  ventured  to  travel  away 
and  were  attacked  on  their  route,  in  the  new  atmo- 
sphere, and  died.  These  instances  are  numerous. 
Nor  is  this  peculiarity  due  to  cholera  alone.  In  the 
early  transit  of  passengers  across  the  Isthmuses  of 
Panama  and  Nicaragua  to  California,  many  escaped 
the  malignant  ague  of  that  climate,  who,  on  arrival 
at  San  Francisco,  a  healthy  place,  where  ague  is  un- 
known unless  imported,  in  a  few  days  are  down  with 


RfiMOTl!  CAVfie. 


63 


ague;  even  those  who  have  suffered  on  the  route  and 
recover  were  subject  to  a  now  attack  in  the  new 
atmosphere. 

89.  Conqwat  arrested.  The  victorious  Abb  is 
Mirza,  fighting  against  tho  army  of  the  Sultan,  dro^  o 
the  Turkish  army  before  him,  battle  after  battle,  until 
both  armies  reached  Erzoroum,  into  which  fortress  the 
Turks  betook  themselves  for  safety,  repose  and  resist- 
ance. But  here  a  now  and  unconquerable  foe  appeared 
in  the  field.  Cholera  attacked  tho  lines  of  Mirza,  and 
turned  his  victorious  troops  and  banners  into  impo- 
tence. His  lines  were  smitten  by  an  unseen  enemy; 
his  soldiers  became  frightened,  threw  down  their 
arms,  and  fled  in  utter  disorder — a  real  defeat  I 

The  same  thing,  would  have  happened  to  the  army 
of  the  Marquis  of  Hastings,  had  not  a  most  perfect 
discipline  rescued  it.  As  it  was,  the  British  columns 
in  India  have  been  retarded  if  not  arrested  in  their 
operations  more  than  once.  Tho  same  thing  happened 
to  the  Poles  before  Warsaw,  and  snatched  victor/ 
from  them. 

90.  Drunkards.  Although  tho  Hindoos  and  Mus- 
sulmans are  a  temperate  people,  exceptions  are  met 
with,  especially  in  the  largo  towns,  where  drunkards 
are  sufficiently  numerous  to  attract  attention.  It  was 
noticed  that,  after  cholera  had  swept  a  city,  the  pro- 
portion of  known  drunkards  ttiat  escaped  all  attack 


■'     ! 


i    I-  I 


:H 


64 


ASIATIC  CIlOLEttA. 


!1 


excoodod  that  of  tlio  woll  conducted  people.    In  Can  * 
ada,  whoro  the  (Voo  use  of  liquor  is  common  and 
clicap,  for  a  whllo  it  was  proclaimed  generally,  espe- 
cially from  tho  pulpit  and  by  magistrates,  that  the 
drunkardg  woro  carried  off. 

I  denied  thiH  at  tho  time,  but  was  remonstrated 
with  on  tho  ground  that,  even  if  I  were  correct,  it 
was  of  groat  moral  importance  that  the  statement 
should  go  abroad.  But  in  three  months*  time,  tho 
pestilence  ondud,  all  tho  old  notorious  drunkards  re- 
appeared ill  public  &,»  heretofore. 

91.  Jiofl  oropff  (imd  had  grain,  as  rice.  Dr.  Tyt- 
ler  endeavored  to  fthow  that  bad  rice  produced  chol- 
era; but  thin  wan  at  a  time  when  cholera  was  raging, 
and  no  doubt  umny  poor  persons  ate  of  bad  rice. 
However,  It  in  woll  known  that  after  even  a  good 
meal  of  HOund  food,  some  unknown  thing  will  cause 
an  arrest  or  vitiation  of  digestion,  followed  by  spon- 
taneous or  sporadic  cholera,  resembling,  in  many  of 
its  symptomis,  Asiatic  cholera;  but  all  those  reported 
cases  arc  defcotlvo  Ui  many  points  as  regards  cholera. 


CHAPTER  III. 


COMMON  SPORADIC   CHOLERA  MORBUS. 


02.  Cholera  morhits  and  cholera  spasmodica,  or 
Asiatic  cholera,  ar*  two  distinct  states  of  tlie  body. 
The  first  is  a  disease,  the  second  is  not.  On  account 
of  this  diflference  it  *s  proper  to  mention  at  once  the 
origin  or  etymology  of  the  name.  Cholera  morbus 
has  been  in  use  since  the  time  oi  Hippocrates,  and  is 
supposed  by  Celsus  to  be  ueri'Ted  from  '^oa//,  bile,  and 
'pew,  to  flow — literally,  bile  flux.  It  is  so  described 
by  all  systematic  writers,  who  appear  to  copy  from 
one  another;  all  of  them  define  the  disease:  bilious 
vomiting  and  purging,  gastric  pains,  cramps  in  somo 
cases,  and  prostration.  It  w^ill  not  do  for  me  to  deny 
the  accuracy  of  all  authors  since  a  thousand  years 
past;  but  I  am  "t  liberty  to  say  what  I  know,  and  to 
describe  the  choii;i  a  morbus  I  was  called  on  to  attend 
long  before  and  since  Asiatic  cholera  reached  Canada. 

93.  The  cases  of  cholera  morbus,  now  often  called 
common  cholera,  that  have  come  under  my  notice, 
were  wwaccompanied  by  bilious  matter  in  the  dis- 
charges. At  first,  when  I  was  quite  young  in  the  profes- 


j 


-  -f. 


m 


66 


ASIATIC    CHOLERA. 


sion,  I  turned  to  authors  in  hopes  of  finding  some  excep- 
tional forms  of  the  disease  in  which  bile  was  not  dis- 
charged; but  I  found  all  the  books  exact  transcripts 
of  their  predecessors,  and  was  forced  to  come  to  the 
conclusion  that  I  either  mistook  the  disease,  or  had 
met  with  one  for  which  I  could  find  no  description. 
From  year  to  year,  until  Asiatic  cholera  reached 
Canada,  I  was  called  to  attend  these  nondescript 
cases,  and  often  since.  It  is  now  time  for  me  to  de- 
scribe the  "  common  cholera"  I  have  in  view,  and  as 
I  saw  it.  The  cases  invariably  occurred  to  persons 
in  previous  perfect  health,  adults  of  both  sexes; 
scarcely  ever  in  the  winter  months,  but  might  be  ex- 
pected in  any  warm  summer  night,  more  so  when  a 
thunder  shower  supervened  to  suddenly  alter  and 
cool  the  atmosphere.  An  individual,  quite  well, 
might  eat  a  hearty  supper  with  good  taste  and  appe- 
tite, go  to  bed  well,  fall  into  a  sound  sleep  of  two  or 
more  hours'  duration,  and  be  awakened  after  midnight- 
and  before  three  in  the  morning  with  an  uneasy  feel- 
ing, nausea,  quickly  followed  by  vomiting  and  purg- 
ing. The  first  matter  thrown  up  was  the  supper,  ap- 
parently unaltered,  after  this  there  was  a  continuous 
watery  vomiting;  the  first  stool  or  two  consisted  of 
the  accumulated  feculent  matter,  after  that  the  intes- 
tinal discharges  were  also  watery,  without  odor  and 
without  colicky   pains,      The  discharge    from  tho 


COMMON   SPORADIC    CHOLERA  MORBUS. 


6T 


stomach  was  also  without  odor,  or  taste  to  the 
patient.  In  none  of  these  discharges,  either  upward 
or  downward,  was  there  any  bile,  notwithstanding  the 
convulsive  vomiting  which  might  be  expected  by  its 
compression  of  the  viscera,  liver  and  gall  blader, 
would  be  likely  to  emulge  the  )/ile  into  the  stomach 
and  intestines.  In  some  cases  cramps  came  on,  the , 
skin  grew  mois!;,  and,  in  protracted  cases,  cold;  in 
severe  and  protracted  eases  the  voice  failed  a  little; 
sanguineous  stasis  became  apparent  in  the  skin,  but 
not  to  a  degree  amounting  to  the  cyanosis  seen  in 
Asiatic  cholera.  The  most  prominent  symptom  was 
vomiting,  the  stomach  being  so  sensitive  as  to  be 
unable  to  endure  more  than  a  tablespoonful  of  fluid. 
It  was  this  instability  that  made  the  difficulty  to 
treat  the  case,  for  medicine  in  the  form  of  draught 
was  too  voluminous  to  be  retained  long  enough  to 
calm  the  fretful  state  of  the  organ.  On  this  account 
it  was  that  the  patient  was  directed  to  swallow,  as 
best  he  could,  a  pill  of  one  grain  of  pure  opium, 
without  any  vehicle.  If  this  could  be  retained  for 
lialf  an  hour,  it  was  sufficient  to  calm  the  stomach, 
arrest  the  discharges  and  cramps,  if  those  happened 
to  exist.  It  must  be  noticed  that  the  patient  is  always 
very  restless  and  tosses  about  the  bed;  so  sure  as  this 
movement  is  permitted  or  indulged  in,  the  opium  pill 
will  not  remain  on  the  stomach — vomiting  will  con- 


/ 


i 


1-i 


IT 


•I 

■,   'I 
.ill 


1. 


t 


■■ll 


M 


f! 


'I 


Us 


ASIATIC   CHOLERA. 


tlnue;  the  most  perfect  quietude,  even  of  speech, 
must  be  persevered  in.  One  pill  will  generally  arrest 
the  great  disturbance,  and  the  patient  will  be  well 
the  next  day,  excepting  the  debility  and  the  soreness 
of  the  abdominal  muscles.  When  the  case  has  been 
permitted  to  go  on  for  a  few  hours,  prostration 
becomes  too  great  to  be  rallied  from,  the  cold  surface 
continues,  sometimes  with  slight  lividity  of  the  skin 
and  nails;  the  pulse  becomes  Imperceptible  at  the 
wrist,  the  heart  acts  feebly;  consciousness  remains 
clear  from  the  first,  at  last  becomes  obtuse;  restless- 
ness ceases,  prostration  increases,  and  the  patient  dies 
imperceptibly,  without  a  pang  or  struggle.  In  some 
few  of  these  severe,  unarrested  cases,  the  colliquation 
will  cease,  giving  hope  of  recovery.  The  patient 
does  so  to  some  extent  for  a  while,  but  the  loss  from 
the  system  ha?  been  too  great;  life  has  been  too 
largely  dissipated,  and  what  little  remains  can  only 
flicker,  is  insuflScient  to  revivify  what  remains  of  the  - 
worn-out  fabric. 

There  is  great  thirst,  of  course,  and  it  is  useless  to 
give  the  water  called  for,  since  it  will  be  rejected  as 
goon  as  down;  but  when  the  pill  has  had  its  eflfect,  a 
spoonful  at  a  time  may  be  given,  gradually  increasing 
the  quantity. 

94.  I  have  never  seen  a  case  that  occurred  after 
sunrise.    I  do  not  remember  one  that  was  not  pre- 


COMMON  SPORADIC   CHOLERA   MORBUS. 


69 


ceded  by  perfect  health,  a  hearty  meal  before  bed- 
time, sound  sleep,  out  of  which  the  patient  is  awak- 
ened by  the  attack  between  11  p.m.  and  2  or  3  a.m.,' 
rarely  before  or  after  these  hours. 

The  foregoing  description  of  wliat  is  now  called 
common  cholera,  or  cholera  morbus,  does  not  perfectly 
correspond  with  the  disease  so  named  in  medical 
works.  While  I  would  not  dare  deny  the  correct- 
ness of  the  numerous  authors  who  have  classified  and 
described  the  so-named  disorder,  I  must  say,  for 
myself  J  that  /have  encountered  none  other  than  the 
form  now  imperfectly  described. 

To  illustrate  the  foregoing,  and  make  myself  more 
accurately  understood,  I  shall  give  a  few  cases. 

95.  1st.  That  of  Messire  Beddard,  a  distinguished 
prelate  of  the  Sulpician  Seminary,  in  Montreal.  He 
was  taken  ill,  after  his  first  sleep,  in  the  night.  The 
medical  atteudant  of  the  house  was  called  to  his 
assistance,  and  prescribed  as  he  saw  fit.  The  violence 
of  the  attack  was  over  in  a  few  hours,  although  liquid 
dejections  continued  in  small  quantity  for  some  time 
after.  Hope,  scarcely  any  doubt,  was  entertained  of 
his  recovery,  after  the  storm  had  passed.  But, 
although  the  discharges  had  ceased,  ho  did  not  pro- 
gress in  regaining  strength.  He  rallied  for  a  while, 
and  again  seemed  less  well.  I  was  sent  for  about  40 
hours  after  the  attack.  1  found  him  dressed  in  his 
4* 


■  i- 

-» 

*'  I' 

;.  j. 


I 


i    t  i 


Hi 


Si 


[I 


ill 


I  ;  1 

i  r 


ll 


Mi 

■'MM  I 


; 


!'i 


t ! 


vi 


70 


ASIATIC   CHOLERA. 


gown,  standing  in  the  middle  of  the  room,  surrounded 
by  friends.  He  looked  ghastly;  with  a  husky  voice 
he  requested  acid  drink,  craved  for  clotted  milk,  du 
lait  caiUe,  above  all  other  things.  This  his  physician 
interdicted,  and  on  this  account  I  was  called  in. 
I  approved  of  his  taste,  which  T  took  to  be  an 
indication  of  what  his  stomach  was  capable  of 
appropriating — a  very  grateful  article  of  food,  very 
digestible  from  the  natural  admixture  of  lactic  acid 
with  the  curd,  much  consumed  by  the  French  Cana- 
dians. He  ate  some,  with  a  little  maple  sugar  and  a 
few  mouthfuls  of  bread;  he  wanted  more,  but  was 
then  restrained;  it  agreed  well  with  the  stomach; 
but  he  grew  more  and  more  feeble,  became  slightly 
delirious,  and  died  some  50  hours  after  the  attack, 
July  2d,  1825,  aged  58  years. 

96,  2d.  Cammeron,  Dorchester  street,  a  healthy 
and  strong  man,  ate  a  moderate  supper  of  stewed  mut- 
ton and  potatoes  (left  from  dinner)  at  8  p.m.;  went 
to  bed  at  10,  feeling  quite  well.  He  was  awalened 
at  the  end  of  his  first  bleep  by  an  uneasy  but  painless 
sensation.  Vomiting  came,  first  of  the  stew  he  bad 
eaten,  unaltered,  next  of  a  mawkish,  watery  fluid, 
repeated  in  gushes  as  fast  as  it  accumulated;  the 
parallel  of  this  took  place  by  the  bowels,  urged  by 
violent  abdominal  contractions,  but  no  colicky  pain 
or  bile  could  be  detected.    Pulse  scarcely  perceptible 


■     iliir 


COMMON  SPOBADIO   CHOLERA  MORBUS. 


71 


when  I  saw  him  at  2  a.m.;  skin  cold  and  clammy, 
some  cramps  in  one  leg,  breatliing  easy  and  natural, 
with  an  occasional  sighing  respiration;  voice  much 
enfeebled;  very  restless.  The  first  thing  done  was  to 
deprive  him  of  water,  which  he  craved  much,  and 
rejected  in  gushes  as  soon  as  swallowed;  the  exertion 
of  vomiting  was  a  source  of  more  exhaustion.  From 
experience  I  well  knew  that  a  carminitive  draught, 
from  its  mere  bulk,  could  not  be  retained.  One  grain 
of  solid  opium  was  got  down,  and  by  much  persuasion 
and  close  watching  he  was  kept  from  tossing  about, 
since  this  alone  would  keep  up  the  irritability  of  the 
stomach  and  the  retching.  In  half  an  hour's  timothe 
retchings  had  diminished,  the  pill  remained  down,  he 
grew  easy.  A  little  later  he  became  dozy,  and  in  an 
hour  was  allowed  to  take  a  spoonful  of  water  at  inter- 
vals, gradually  increasing  the  quantity,  as  it  was 
thought  the  stomach  could  bear.  All  the  trouble  sub- 
sided into  a  good  sleep,  out  of  which  he  awoke  nearly 
well,  with  the  exception  of  thirst,  a  few  muscular 
pains,  and  weakness.  In  twenty-four  hours  he  had 
quite  recovered. 

Camraeron's  case  may  be  taken  as  a  type  of  sporadic 
cholera  that  usually  occurred  in  my  practice  in  the 
hot  summer  months  of  Canada  at  Montreal;  and  the 
treatment  I  adopted  was  adopted  by  the  very  able 
and  experienced  Dr.  Arnoldi,  sen.,  and  a  lew  others. 


Vi 


} 


}• 


f 


\4 


■\  A 


Ui;ii! 


fin 


'.  :i 


72 


ASIATIC   CHOLERA. 


I  shall  now  give  a  third  case,  one  in  which  no  med- 
ical treatment  was  had  recourse  to  until  the  malady 
had  run  its  course  aiid  all  dirieharo'es  had  ceased. 

9V.  3d.  Bartli'4I<;nj  I'EspagiiOle,  a  native  of 
Spain;  a  tall.  lean,  wiry  raan  abinu  >0  years  of  age; 
he  lived  at  the  top  of  SanguinetLe  street,  his  house  in 
a  small  ;j^arden,  which  he  cultivated,  and  which  sup- 
plied the  wants  of  his  wife  and  ai  oni/  daughter;  went 
to  bed  in  perfect  health  on  a  Sunday  night;  was 
awakened  wrih  vomil ing  a.id  purging,  some  cramps. 
He  had  no  one  else  than  his  young  daughter  to  send 
for  assistance,  through  a  long  and  lonely  street,  which 
he  and  his  wife  objected  to.  I  saw  him  about  9  a.m., 
found  him  pulseless,  cold,  clammy,  breathing  easily, 
with  an  occasionaJ  deep  drawn  sigh;  very  thirsty. 
He  had  his  senses,  but  was  silent.  This  old  man  had 
very  little  substance  to  lose,  was  soon  run  out,  and 
died. 

98.  4th.  One  more  case,  since  to  me  it  appeared 
very  interesting.  Mrs.  Cowing  had  just  recovered 
from  typhus  of  nearly  five  weeks'  duration.  Her  con- 
valescence was  rapid,  and,  as  io  usual  at  such  time, 
her  appetite  was  extraordinary.  On  Sunday  there 
was  roast  pork  for  dinner,  of  which  she  ate  very 
heartily,  and  at  10  p.m.,  while  in  bed,  she  craved  more, 
and  was  served  with  more.  Her  husband,  a  florid, 
robust  and  healthy  nmn,  ate  also  of  the  same  pork  at 


COMMON  SPORADIC   CHOLERA  MORBUS. 


73 


dinner,  at  2  p.m.  In  the  evening  he  took  his  tea, 
etc.,  as  usual,  feeling  quite  well;  retired  to  bed  at  10 
P.M.J  about  2  A.M.  he  was  awakened  with  vomiting, 
purging  and  cramps.  The  pork  was  the  first  matter 
rejected,  unchanged^  although  it  had  remained  in  his 
stomach  abort  twelve  hours;  all  the  other  ingestahad 
digested.  When  I  saw  him  he  was  nearly  pulseless, 
cold  and  clammy;  his  florid  cheeks  were  now  slightly 
blue.  Opium  answered  in  his  case  like  in  those 
already  described.  His  wife,  who  was  only  recover- 
ing from  a  protracted  fever,  did  not  experience  the 
slightest  disturbance  from  the  same  food  that  had 
acted  £0  deleteriously  on  her  husband. 

99.  This  case  is  interesting,  as  showing  how  food 
will  prove  nearly  poisonous  at  times  to  one  person 
and  not  to  another,  particularly  as  regards  the  woman, 
who  was  still  in  a  state  of  great  debility,  but  whose 
appetite  was  voracious;  whatever  is  craved  for  will 
suit  the  stomach,  in  preference  to  that  which  is  not. 
This  is  another  example  of  what  hypothesists  seized 
hold  of  in  arguing  against  cholera  contagion.  They 
said:  "  If  contagious,  how  come  it  that  I,  who  was 
exposed,  did  not  take  the  disorder?"  And  in  like 
mannur  Mrs.  Cowing  might  have  said,  "  Why  did  not 
the  pork  serve  me  in  the  same  way,  if  pork  was  the 
cause  of  my  husband's  trouble  ?" 

Until  1817  cholera  was  unnoticed  as  being  com- 


11' 


i 


i:  i  S 


H:| 


If  J 


H 


M' 


74 


ASIATIC   CHOLERA. 


municable.  So  was  it  in  the  sporadic  cholera  of 
Canada;  but  when  the  cases  had  become  numerous, 
under  what  circumstances  is  unknown,  it  put  on  an 
additional  character,  which  it  has  maintained  ever 
Binoc;  and  so  it  has  ever  been  with  every  known  con- 
tagion, 

100.  Up  to  1832  I  had  carefully  road  what  was 
published  of  Indian  cholera,  and  the  fierce  polemics 
on  contagion  and  non-contagion.  The  printed  de- 
scriptions of  the  cholera  of  India  appeared  to  me  to 
be  exactly  like  the  sporadic  cholera  of  Canada,  and  I 
joined  in  the  opinions  of  the  non-contagionists.  But 
how  soon  was  I  undeceived  I  V/hen  I  came  to  see 
the  imported  cases,  while  the  symptoms  appeared  to 
diflfer  only  in  degree,  it  was  striking  to  the  sight  of 
the  beholder  of  a  case  that  there  was  a  great  differ- 
ence, but  what  difference  words  can  not  point  out, 
more  than  a  witness  can  define  what  difference  there 
is  between  two  cour  'enances— each  face  possesses  the 
same  parts,  eyes,  nose,  mouth,  etc.,  etc.,  yet  a  witness 
can  honestly  swear  to  one  person  as  positively  differ- 
ing from  another;  and  so  can  any  one  say  from  the 
first  sight  of  a  case  of  Asiatic  cholera  that  it  is  not  a 
case  of  common  cholera. 

101.  I  have  ventured  to  say.  Sec.  92,  that  Asiatic 
cholera  is  not  a  disease.  I  have  often  so  stated  to 
medical  men,  to  their  astonishment  and  contradiction. 


COMMON  SPORADIC   CHOLERA  MORBUS. 


75 


After  listening  to  a  long,  lame  physiological  and  even 
metaphysical  argument,  I  have  asked  one  simple  qued- 
tion :  What  is  disease  ?  Until  now  I  have  not  mot 
with  a  single  one  of  the  ready  arguraentators  who  has 
been  capable  of  answering  the  questioit.  All  writers 
and  all  remarks  of  medical  men  mention  cholera  as  a 
disease^  which  expression  I  take  to  be  an  erroneous 
one  when  applied  to  this  pestilence,  and  that  it  is  a 
term  which  has  warped  the  medical  mind,  by  a  mere 
word,  into  a  vast  variety  of  contradictory  opinions, 
endless  discussions,  and  absurd  medication.  It  is 
accepted  by  the  profession  as  a  short  and  convenient 
way  of  designating  the  existence  of  something  wrong, 
somewhere,  in  a  part,  or  even  in  the  whole  system; 
but  it  convoys  no  idea  of  what  this  something  is.  On 
this  account  I  have  ventured  on  the  difficult  and  new 
task,  that  oi  giving  a  definition  to  a  word  heretofore 
bandied  abf*at  loosely,  meaning  something,  but  what 
that  thing  is  no  one  has  stopped  to  inquire.  My 
effort  in  this  respect  is  a  new  one,  no  doubt  very 
imperfect,  but  it  is  hoped  will  excite  the  abilities  of 
more  able  physiologists  than  the  writer  has  any  pre- 
tension to  be,  and  that  hereafter  the  phrase  "  diseased 
action"  will  be  less  flippantly  uttered. 

102.  Disease  is  a  disturbance  in  and  among  the 
molecules  constituent  of  any  tissue  of  the  living  body. 

The  natural  function  of  the  molecular  matter  is 


'  / 


N 


f 

in 


1 


!l 


1     J  i. 


■  1  .; 


If 


M   l 


76 


ASIATIC  CHOLERA. 


1: 


perturbatcd,  but  is  not  destroyed.  Disease  does  not 
arrest  their  whole  action,  only  modifies  it  for  a  while, 
until  the  disease  becomes  exhausted,  and  is  followed 
by  recovery,  or  is  arrested  by  death.  During  a 
diseased  state  the  molecules  still  functionate  more  or 
less  perfectly,  but  functionation  is  not  suspended. 
Innervation,  nutrition,  secretion,  and  absorption  oc- 
cur; that  is,  new  matter  is  formed,  old  structures  are 
removed  or  greatly  altered;  deposits  of  fibrin  or 
serum  or  pus,  or  new  organizations,  take  place;  this 
is  disease.  None  of  these  characteristics  of  disease 
aro  met  with  in  cholera.  Examples  of  diseased 
action:  1.  The  sensorium  is  obscured  or  over-excited, 
but  perception  continues,  is  not  suppressed.  2.  The 
lungs  may  be  variously  perturbatcd,  but  still  continue 
to  functionate — take  in  oxygen  and  give  out  carbonic 
acid  gas  and  vapor.  3.  The  stomach  may  not 
chymify  completely,  but  still  does  so  to  some  extent. 
4.  The  liver  may  be  exceedingly  disturbed,  but  the 
portal  circulation  is  still  carried  on,  and  bile,  such  as 
it  is,  vitiated  or  otherwise,  is  secreted.  5.  Kidneys 
may,  like  the  liver,  be  much  perturbatcd,  greatly  or 
slightly,  but  still  eliminate  more  or  less  excrement 
from  the  body.  6.  In  inflamma-tion  the  extreme 
vessels  are  perturbatcd,  swell,  even  the  structure  con- 
taining them  becomes  infiltrated,  but  physiological 


lii. 


COMMON  SPORADIC   CIIOLEBA   MORBUS. 


77 


action  is  not  completely  Buspondod.    So  on  we  might 
go  through  the  whole  catalogue  of  nosology. 

103.  How  diiferent  in  cholera  1  It  alters  suddenly 
all  the  physiological  actions  of  the  molecules  it 
attacks,  annihilates  completely  all  function  while  its 
influence  lasts.  To  illustrate  the  idea  I  entertain  of 
the  operation  of  the  choleraic  poison  producing  death 
without  the  intervention  of  **  diseased  action,"  I  shall 
cite  a  few  instances  of  death  occurring  in  the  complete 
absence  of  any  possible  disease,  1.  A  man  falls  from 
a  height,  is  taken  up  apparently  dead,  and  j  cmains 
dead.  In  some  of  these  cases,  no  bones  are  broken,  no 
vessels  ruptured,  no  apparent  lesion  can  be  detected; 
but  he  is  dead:  surely  disease  did  not  kill  him.  2.  One 
is  shot  through  the  heart  and  is  instantly  killed,  before 
blood  has  had  time  to  escape  in  any  quantity  to  be 
accused  as  the  cause  of  death;  no  disease  acted  here. 
3.  A  man  descends  into  a  fermenting  vat;  he  dies 
instantly,  without  disease;  but  physiologists  of  the 
schools  say  something  about  the  arrest  of  oxygen 
reaching  the  lungs,  etc.,  but  cholera  refutes  the  doc- 
trine. 4.  A  drop  of  prussic  acid  put  into  the  eye  of  a 
dog  will  kill  instantly;  bore  no  disease  has  had  time 
to  be  induced.  So  on  we  may  go,  citing  numerous 
examples. 

104.  If  we  contemplate  with  close  attention  various 
cases  of  cholera,  we  shall  find  numerous  examples  of 


t 


i  ? 


78 


AWATrO    CHOLERA. 


I '"I 


ill!! 

F'i  i 

■•  'IT 


death  takinpf  ploco  m>  middenly  that  no  possible  disease 
had  time  to  aNHht  In  the  catastrophe.  Some  persons 
in  perfecthealtli  have  been  stricken  dead,  it  is  reported, 
in  fifteen  miiiuteN,  oren  without  discharges;  but  in  all 
these  sudden  cones  cyanosis  was  present  My  case, 
cited  Sec.  175,  mnit  have  died  very  suddenly.  If,  on 
the  other  hand,  wo  contemplate  a  less  astounding 
case,  we  shall  i06  that  great  numbers  were  severely 
attacked,  and  In  twelve  hours  the  colliquation  had 
completed  its  work  and  left  its  victim  well;  nothing 
but  weakness  fullowod.  Does  disease  act  thus  7  I 
cannot  afford  to  extend  this  small  book  further,  else 
I  might  cite  a  largo  volume  in  support  of  my  assertion. 
Cholera  is  not  a  dinease.  Reader  I  do  not  believe  me, 
but  learn  for  yourielf,  as  I  have  done.  The  delusions 
created  by  education  are  delightful;  so  that,  few 
things  are  more  painful  to  the  deluded  than  an  attack 
upon,  or  a  rofutation  oif,  their  fond  and  long  cherished 
errors.  . ,  ...  ,,  .. ,,  . ,  ,.;,.■.•■,,  , 

106,  It  may  bo  onkod  by  some  one:  what  good  can 
a  verbal  distinction  make  ?  1.  In  reply,  I  say  the 
difference  is  not  in  words  but  in  facts,  as  has  been 
clearly  sliown^  a  wrong  name  leads  to  a  misconcep- 
tion of  the  thing  named.  2.  The  practitioner  who 
calls  cholera  a  diHoa«e  will  carry  into  practice  liis 
habits  of  treating  dinease  where  none  exists,  and  work 
up  for  his  guidance  the  idea  of  an  imaginary  pathol- 


COMMON  8P0BADIG  CHOLERA  MORBUS. 


79 


o^y  and  a  physiology  which  cholera  utterly  reff/  m 
Out  of  this  error  in  a  name  the  wildest  notions  of 
medication  have  been  adopted,  useless  in  all  cases, 
injurious  in  nearly  all,  and  horribly  cruel  to  thi 
patient  in  many,  as  shall  fully  appear  in  the  chapter 
on  Treatment, 


*  I 


; 


'I! 


CHAPTER  IV. 

SYMPTOMS  EXAMINED   IN   DETAIL. 

Invasion  of  a  patient.  In  all  cases  of  cholera  the 
symptoms,  or  rather  the  phenomena,  are  exactly  the 
same ;  they  differ  only  in  degree.  In  some  slight 
attacks  they  do  not  all  appear  to  take  place,  or  rather 
are  less  noticeable;  and  in  some  rare  cases  the  victim 
is  at  once  prostrated  and  killed  in  a  few  mlDutes — he 
is  overcome,  and  cannot  seek  or  call  for  assistance, 
and  dies  where  he  happens  to  be.  Such  cases  are 
reported,  by  respectable  authority,  to  have  ended  in 
death  in  fifteen  minutes. 

106.  The  invasion  is  very  variable  as  regards 
admonition  or  not;  some  have  no  previous  warning, 
but  the  majority  have.  A  gentleman,  in  the  habit  of 
taking  a  ride  before  breakfast,  mounted  his  horse  as 
usual,  feeling  in  perfect  health.  He  had  not  gone  far 
when  an  uneasy  feeling  came  over  him;  he  sickened, 
and  was  conveyed  back  to  his  house;  vomited  copi- 
ously many  times,  purged  the  same  without  the 
slightest  colic  pains;  his  skin  became  clammy,  wet, 
cold  and  cyanosed;  had  a  few  cramps  in  the  legs;  had 


in 


\ 


BYMPTOMS  EXAMINED  IN  DETAIL. 


81 


taken  brandy  and  opium;  and  by  evening,  a  period  of 
twelve  hours,  the  colliquation  had  completely  ceased; 
he  slept  well,  and  next  morning  had  quite  recovered, 
with  the  exception  of  being  weak  and  thirsty. 

107.  The  governor  of  Madras,  Sir  Thomas  Munro, 
sat  down  to  breakfast  in  perfect  health,  but  was  sud- 
denly interrupted  in  his  repast,  being  overcome  in  an 
indescribable  way;  he  grew  cold,  skin  clammy;  said 
to  his  aide*de-camp,  "  I  am  an  infected  man,  and  shall 
die."  He  did  die  in  ten  hours.  Men  on  sentinel  duty, 
men  at  guard-mounting,  who  rose  in  the  morning  in 
perfect  health,  ate  breakfast  as  usual,  and  marched 
with  their  accustomed  smartness  to  the  parade,  were, 
without  the  least  premonition,  attacked  and  pros- 
trated; men  in  their  usual  health  were  suddenly 
stricken  while  marching;  mounted  men,  unconscious 
of  any  thing  wrong  in  them,  were  suddenly  dis- 
mounted. These  cases  were  numerous,  public,  and 
ojficially  reported.  The  same  came  under  my  own 
observation,  as  the  case  mentioned,  Sec.  175  ;  that  of 
the  soldier  on  a  visit  to  his  fresh  arrived  friends  on 
the  night  of  the  9th  to  10th  June;  that  of  the  old 
man's  wife  at  Contrecour,  and  one  or  two  in  the 
Chesser  family. 

108.  But  the  majority  of  cases  had  suffered  a  period 
of  incubation  after  exposure,  during  which  incubation, 
seldom  reaching  to  four  days,  they  remained  perfectly 


>\ ,  ] 


i 


li 


!     'I 


I: 


82 


ASIATIC   CHOLERA. 


U: 


'ii: 


well,  when  at  last  the  attack  would  occur  as  suddenly 
as  in  all  other  cases.  This  interval  of  time  suggested 
the  idea  that  the  poison  had  to  grow  to  a  sufficient 
amount,  or  sufficient  virulence,  before  it  could  over- 
come the  natural  healthy  action  carried  on  in  the 
patient;  when  it  arrived  at  that  point  the  attack 
became  manifest  as  in  every  other  case,  sudden,  more 
or  less  violent,  perhaps  in  conformity  with  the  tem. 
perament  of  the  victim. 

109.  A  regular  attack  takes  place  with  an  in- 
variable set  of  symptoms  of  more  or  less  severity, 
preceded,  in  some  cases,  by  an  uneasy  feeling  of  not 
being  quite  right.  The  patient  is  soon  prostrated;  a 
cold  perspiration,  or  rather  transudation,  breaks  out 
over  the  whole  body  and  limbs,  which  quickly  assume 
a  leaden  color,  may  deepen  to  blue,  or  even  to  brown, 
according  to  the  natural  tint  of  the  patient.  The 
fingers,  toes,  arms  and  legs  quickly  diminish  in  size; 
the  skin  is  wrinkled,  shriveled,  especially  that  of  the 
fingers,  which  are  reduced  in  thickness  one-third  of 
their  previous  size;  the  superficial  veins  are  easily 
seen  as  dark,  or  nearly  black,  lines;  the  temperature 
is  rapidly  reduced  below  that  of  a  dead  subject;  the 
patient  all  the  time  complains  of  feeling  hot.  In  all 
this  "  cold  stage,"  as  it  has  been  called  by  a  supposed 
analogy  to  fevers,  th  j  is  never  the  slightest  shiver- 
ing, chattering  of  the  teeth  or  trembling  that  is  met 


m  size: 


SYMPTOMS  EXAMINED  IN   DETAIL. 


88 


with  in  the  cold  stage  of  ague;  on  the  contrary,  the 
patient  invariably  complains  of  heat,  wants  exposure, 
and  will  not  suffer  covering,  excepting  of  the  lightest 
kind.    The  pulse  soon  becomes  imperceptible  at  the 
wrist,  and  in  a  short  time  it  cannot  be  felt  as  high 
up  as  the  axilla,  but  what  pulse  can  be  felt  is  scarcely 
quickened  in  number;  on  listening,  the  heart  is  still 
heard  acting  feebly.    Vomiting  soon  succeeds,  and 
purging,  by  gushes,  in  astonishing  quantity,  of  a  cold, 
grayish-white  fluid,  resembling  thin  gruel,  or  "  rice 
water,"  devoid  of  odor  or  taste  (to  the  patient),  and 
without  colic;  cramps,  in  the  legs  mostly,  less  fre- 
quently and  severe  in  the  arms,  occur.    The  abdomi- 
nal muscles  also  are  cramped;  but  the  cramp  pain  is 
less  severe  here  than  in  the  legs;  the  "bellies"  of  the 
muscles  appear  prominent  between  the  tendinous  in- 
tersections; the  whole  belly  is  drawn  in.    Inspiration 
is  disturbed  only  slightly,  in  some  few  cases  a  little 
quickened,  iu  all  .  ~  voluntary;  deep  inspiration  can 
largely  expand  the  chest,  and  a  long  drawn  sigh  every 
now  and  then  takes  place,  to  end  in  a  peculiar  hollow 
moan.    The  expired  air  is  quite  cold,  so  is  the  mouth 
and  tongue.    The  voice  is  peculiar  and  sepulchral  in 
tone,  approaching  to  aphonia.    The  eyes  are  deeply 
set  in  their  orbits,  and  quite  dry;  no  tears  are  pro- 
duced even  during  the  deep  anxiety  and  anguish  of 
friends  and  relatives  present.    The  countenance  be- 


15 


^1 


™'  1 


h 


9  It 

n, 


:i   j 


»i      ( 


84 


ASIATIC   CHOLERA. 


comes  more  cadaverous  and  ghastly  than  by  death 
under  any  other  form  of  disease. 

Great  restlessness  prevails  while  the  patient  has 
strength  to  toss  about  on  his  bed;  he  lies  mostly  on 
his  sides,  curled  up,  until  near  death,  when  he  may 
settle  on  his  back.  His  mind  is  clear  to  the  very 
last;  he  knows  all  that  is  passing,  but  is  taciturn  and 
speaks  only  in  answer  to  questions.  His  perceptions 
are  all  natural,  excepting  that  of  external  sensation, 
which  he  complains  of  as  being  hot,  while  he  is 
cadaverously  cold,  and  cannot  bear  the  weight  of 
covering.  He  complains  of  intense  thirst,  and  in- 
cessantly calls  for  water,  cold  water,  which  is  no 
sooner  swallowed  than  is  rejected  with  a  gush. 
Urine  is  totally  suppressed;  but  there  is  a  constani 
desire,  in  the  male,  to  void  it.  At  last  the  patient 
becomes  seemingly  insensible — he  is  dying;  but  never 
is  there  heard  a  throat  rattle;  he  dies  quietly,  without 
a  pang  or  struggle. 

A  severe  case,  like  that  which  is  just  described, 
generally  dies  in  twelve,  sometimes  in  eight,  six,  or 
even  less  hours. 

110.  Some  such  cases  seem  to  have  run  and  com- 
pleted their  course  in  eight  to  twelve  ho'  ;  the  in- 
fection or  cataclysm  appears  to  have  exiiausted  itself, 
leaving  the  patient  prostrated,  with  no  apparent  re- 
mains of  the  complaint,  excepting  the  persistence  of 


SYMPTOMS  EXAMINED   IN   Li!.TAIL. 


85 


m    1 


the  dark  color  of  the  surface,  but  which  gradually 
diminishes  with  the  return  of  the  circulation  and  the 
resumption  of  the  pulmonary  function  of  aeration, 
both  of  which  had  been  completely  arrested  during 
the  cyanosed  sfate.  Such  a  patient  loses  his  restless- 
ness and  resumes  his  voice  to  some  extent,  gives 
hopes  to  his  friends;  but  too  often  it  happens  that  life 
only  struggles  on  for  a  day  or  two  more,  when  he 
sinks  forever.  Some  of  these  cases  resist  death  a 
while  longer,  and  put  on  that  peculiar  state  of  the 
system  said  by  many  writers  to  be  the  "  typhoid  stage;" 
but  this,  on  careful  observation,  presents  nothing  to 
justify  such  a  name.  This  apparent  fever  is  simply 
an  effort  to  rid  the  system  of  a  portion  of  the  poison 
that  remained  after  the  undescribable  evacuations 
had  ceased  and  not  carried  all  off,  and  is  also  an  effort 
of  nature  at  recovery. 

111.  A  less  severe  form,  but  still  of  the  collapse 
kind,  is  often  met  with,  excepting  of  less  severity  and 
duration.  Many  of  these  cases  are  soon  over;  the 
discharges  by  the  skin,  stomach  and  bowels  being 
very  free;  cyanosis  is  less  deep,  cramps  less  severe, 
emaciation  less,  breathing  about  the  same,  and 
aphonia;  the  expired  air,  tongue  and  surface  are 
cold;  pulse  extinct  at  the  wri;5t;  urine  "-uppressed, 
etc.  Such  a  patient  may  be  seen  up  and  about  the 
next  day;  he  is  only  weak,  easily  tired,  and  much  re- 


! 


1 1 

I 


I      ! ' 


86 


ASIATIC   CHOLERA. 


i   1 


duced  in  weight  and  plumpness;  he  is  well.  In  this 
case  it  would  appear  that  the  poison,  whatever  it 
may  be,  was  quickly  all  carried  off  by  the  discharges, 
or  it  had  qiute  expended  its  force. 

112.  In  the  mild  cases,  cold  and  wet  skin  and 
cold  tongue  constitute  part  of  the  attack.  The  circu- 
lation is  not  completely  arrested,  hence  cyanosis  is 
absent,  or  nearly  so;  there  may  be  some  vomiting 
and  purging,  but  no  cramps,  and  the  voice  is  scarcely 
altered;  urine  is  not  totally  suppressed,  but  passed  in 
small  quantity  oi\Ij,  Such  cases  may  last  longer 
than  the  second  form.  The  prostration  and  loss  of 
substance  is  slightc  It  would  appear  that  in  this  last 
form  the  poison  had  made  only  a  slight  impression  on 
the  system,  and  is  eliminated  slowly. 

113.  Cholarine,  a  name  given  to  a  diarrhoea  that  is 
often  met  with  some  days  a/ter  the  great  onset  and 
force  of  an  invasion  has,  to  a  considerable  extent, 
exhausted  itself.  This  name  was  invented  by  Parisian 
practitioners  to  distinguish  such  cases  from  real 
cho^lcra.  It  is  rarely  met  with  in  the  first  days  or 
week  of  an  invasion.  The  stools  are  feculent  in 
appearance  and  odor,  are  liquid,  brown,  not  fre- 
quent, and  in  small  quantity,  unaccompanied  with 
colic,  or  only  so  in  a  slight  degree.  I  have  often 
considered  these  cases  and  had  good  reason  to  believe 
that  many  of  them  were  due  to  mental  anxiety  acting 


t-l    ! 


SYMPTOMS  EXAMINED   IN   DETAIL. 


87 


on  the  bowels.  This  diarrhoea  is  easily  controlled 
by  a  judicious  use  of  opium,  reasonable  diet,  and  an 
assurance  given  to  the  patient  that  he  is  not  affected 
with  cholera;  in  this  way  the  patients  nearly  all 
recover.  But  a  certain  number  of  real  attacks  are 
preceded  by  this  derangement  of  the  bowels,  which, 
I  feel  confident,  is  not  a  part  or  necessary  forerunner 
of  an  attack.  Why  should  not  cholera  supervene  on 
such  a  diarrhoea,  when  we  see  cholera  attack  persons 
laboring  under  acute  diseases,  as  fever,  typhus  fever, 
even  small-pox  ? 

114.  Between  the  three  degrees  of  cholera  men- 
tioned there  are  many  shades  of  intensity,  from  that 
of  an  astounding  attack  that  kills,  without  previous 
warning,  and  without  discharges,  in  fifteen  minutes 
or  even  less  time;  cases  of  great  and  sudden  collapse; 
and  cases  in  which  there  is  only  a  simple  uneasy  feeling 
with  moderate  discharges.  Kundredshave  died  before 
the  cholera  cause,  the  immediate  cause,  Kas  had  time 
to  coUiquesce  the  tissues  into  the  particular  and 
peculiar  fluid  which,  being  oozed  into  the  stomach 
and  bowels,  excites  the  vomiting  and  purging  usually 
met  with,  and  also  its  transmission  through  the  skin. 
In  these  astounding  cases  death  has  taken  place  in  a 
few  minutes'  time  in  persons  who  have  previouyly 
made  no  complaint  of  feeling  ill.  Marvelous  as  this 
statement  may  seem  to  the  inexperienced,  it  is  cor- 


1  * 


i  ' 


88 


ASIATIC   CHOLERA. 


!■    , 


i 


roborated  by  nearly  a11  the  writers  on  cholera  m 
India,  who,  being  military  oflBcers,  and  their  patients 
of  the  same  class,  their  opportunities  for  exact  obser- 
vation are  greater  than  those  of  cir:l  rc^ctltiders, 
Aviio  have  to  rely  on  the  vague  stater^'^pts  furnished 
by  people  in  a  state  of  confused  excitemenv. 

115.  At  the  risk  of  being  accused  of  repetition,  the 
writer  may  be  permitted  to  refer  once  i  -ore  to  what 
has  already  been  said:  "  At  Bundlecund,  in  the  army 
of  the  M.  of  Hastings,  the  invasion  was  so  sudf'en  and 
violent  that  mounted  men  were  stricken  from  their 
steeds,  fell  and  died  on  the  road;  ....  sentinels, 
after  guard  mounting  and  placed  on  their  posts,  were 
suddenly  overcome,  and  quickly  died."  Such  is  only 
one  of  the  ofi&cial  reports;  the  same  has  occurred 
again  and  again  on  numerous  occasions  in  India,  at 
Malta,  and  even  in  Montreal,  as  shall  be  referred 
to  hereaftQr. 


Let  us  now  proceed  to  contemplate  or  extmine  the 
symptoms,  or  rather  phenomena,  that  occur  in  this 
dire  pestilence.  It  is  difficult  to  decide  on  which 
function  we  should  first  inquire  into,  since  they  all 
depend  on  each  other  in  the  warm  blooded  vertebrate, 
i.  e.  the  nervous,  the  sanguineous,  and  the  aerative  or 
pulmonary  systems;  besides,  also,  they  often  seem  to 
be  all  attacked  simultaneously. 


SYMPTOMS  EXAMINED   IN   DETAIL. 


89 


1 10.  Wiiiit  is  understood  by  the  word  symptom,  as 
met  with  in  nosological  authors,  docs  not  occur  in 
cholera,  excepting  after  the  disorder  has  run  its  course, 
vithout  death,  and  an  eflfort  is  made  by  nature,  as  it 
is  said,  to  restore  the  system  to  health;  then  comes 
that  quasi  fever,  which  has  been  supposed  to  resemble 
typhus,  and  is  erroneously  called  by  that  name. 

117.  Tht  first  symptom ,  or  nervous  one.  A  general 
uneasiness  is  felt — "I  am  unwell."  But  this  even  is 
not  alv.  ays  mentioned  by  the  patient,  for  some  died 
without  making  this  premonitox'y  remark.  When  the 
invasion  of  the  malady  is  well  under  way,  innervation 
is  perverted  in  one  respect  only — the  patient  com- 
plains of  heat,  while  he  is  as  cold  as  a  corpse;  he 
objects  to  be  covered,  wants  the  bed  clothing  removed, 
the  weight  01  which  annoys  him;  a  great  restlessness 
prevails;  he  tosses  or  moves  about  on  his  bed;  during 
all  this  time,  and  to  the  last,  his  intellect  is  undis- 
turbed, and  remains  clear  to  the  last  moment  that  it 
can  be  manifested. 

118.  The  pulmonary  systim,  or  aeration.  Inspira- 
tion and  expiration  take  place,  to  all  appearance,  as 
usual,  excepting  that  there  is  occasionally  a  deep 
inspiration,  followed  by  a  similar  expiration,  resem- 
bling a  sigh,  and  ending  with  something  like  a  slight 
groan.  Th' ;  expired  air,  on  striking  the  hand  or  face 
of  the  practitioner  while  examining  the  patient,  feels 


■', 


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!  \ 


I 


96 


ASIATIC   CHOLERA 


like  a  cold  blast — as  cold  as  the  a'  uosphere.  It  comes 
out  of  the  lungs  unaltered  in  temperature;  and  during 
the  collapsed  or  ;}inosed  state,  even  when  this  lasts 
for  several  hourd,  its  chemical  constituents  remain 
unaltered,  or  nearly  so;  the  lungs  have  taken  nothing 
from  it,  have  given  nothing  back;  that  is,  oxygen  has 
not  been  absorbed,  nor  carbonic  acid  returned  in 
exchange. 

119.  Circulation^  and  the  blood.  FroTU  the  earliest 
examination  of  a  choleraic  patient  the  pulse  will  not  be 
found  much  altered  in  time;  but  it  is  smaller  and 
softer  than  usual,  which  alteration  becomes  more 
marked  as  the  case  progresses;  gradually,  it  ceases 
to  be  perceptible  at  the  wrist,  next  in  the  course  of 
the  humeral  artery,  and  lastly  in  the  axilla.  It  now 
becomes  evident  that  the  heart  is  incapable  of  sending 
the  diminished  column  of  blood  on  which  it  act?)  to 
the  extremities  of  the  arteries.  Although  the  heart 
contracts  and  dilates* with  regularity,  it  does  so  like 
the  heart  of  a  frog  or  turtle,  or  other  low  animal,  from 
an  inherent  power  proper  to  it,  independently,  to  a 
great  extent,  of  the  blood  that  enters  it.  There  is  a 
mere  flux  and  reflux  of  blood  from  and  to  the  ven- 
tricles— a  mere  remora  of  blood  in  motion.  The 
column  of  blood  is  not  driven  to  the  extremities  of 
the  arteries  and  returned  by  the  veins;  in  a  word, 
circulation  has  ceased,  and  still  the  patierft  lives  for 


SYMPTOMS  EXAMINED  IN   DETAIL. 


01 


some  hours.  His  intellect  remains  unclou'lod  to  the 
last,  in  spito  of  theories  that  innist  on  the  necessity  of 
a  full  supply  of  arterial  ])lood  to  the  brain  to  support 
its  function.  Here  wo  find  two  great  functions 
essential  to  life  in  a  well  person  arrested,  or  at  least 
too  much  cri^  pled,  to  supjily  the  wants  of  the  system 
they  wcro  created  to  uphold;  and  the  abseuc  ^ 
which,  i  other  condition  of  the  cconoir.    ' m 

during  c    >i  'sults  in  speedy  death.      But  ui 

cholera  th^  ajaU  u  seems  to  bo  indiflfcrent  to  the  sup- 
pression of  these  two  pjroat  functions,  and  to  the  arrest 
of  physiological  actions,  the  integrity  of  which  has, 
until  now,  been  deemed  essential  to  a  living  warm 
blooded  animal. 

The  red  globules  of  the  blood  cease  to  be  acted  on 
in  the  lungs,  arte'rialized  and  crimsoned,  and  carbon 
given  off;  hence  the  leaden  color  of  the  body,  and  the 
stasis  of  the  blood  in  the  capillary  system  of  the 
tissues. 

120.  Digestion  is  comi)lotely  anniliilated;  conse- 
quently neither  chyme  nor  chyle  are  produced,  and 
no  supply  enters  the  circulation;  besides,  as  circula- 
tion is  arrested,  no  secretions  can  take  place;  hence 
it  is  that  no  urine  is  produced ;  that  ulcers,  acute  or 
chronic  (like  the  varicose)  at  once  dry  up;  that  the 
most  virulent  and  copious  clap  at  once  ceases  (to  be 


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23  WEST  MAIN  STREET 

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92 


ASIATIC   CHOLEBA. 


resumed  when  cholera  has  run  its  course  and  the 
patient  has  recovered). 

121.  Cahrijicaiton,  Red  blood,  that  is,  blood  con- 
taining red  globules,  is  found  in  all  vertebrate 
animals;  in  very  small  quantity  in  fishes,  and  more 
and  more  of  it  as  we  ascend  in  the  scale  towards 
warm  blooded  animals.  In  the  lowest  and  lower 
grades,  red  blood  is  of  no  use  to  the  animal,  and 
appears  to  be  one  of  rudimentary  development  in 
creation  anticipatory  of  a  higher  future  structure 
and  want,  not  needed  in  the  lower  animals. '~     -; 

Many  facts  go  to  prove  that  it  is  the  red  globules 
that  receive  in  the  lungs  the  material  creative  of 
caloric,  which,  by  these  globules,  is  distributed  to  all 
parts  of  the  body.  In  cholera  it  is  self-evident  that 
the  globules  undergo  no  change  in  the  lungs  j  but,  if 
they  did,  the  effect  of  the  change  would  amount  to 
little,  since  the  circulation  of  the  blood  is  arrested, 
and  these  globules  cannot  be  carried  to  the  extremi- 
ties of  the  vessels.  To  this  peculiar  condition  of  tha 
blood  and  the  arrest  of  circulation  is  the  reduced 
temperature  of  the  body  greatly  due ;  but  not 
altogether,  for  the  quick  lowering  of  the  temperature 
of  the  body  of  a  choleraic  patient  is  apparent  in  less 
time  than  could  take  place  from  a  mere  reduction  of 
the  temperature  of  the  blood,  and  the  long  time  a 
deficient  circulation  takes  to  permit  a  vhole  body  to 


p£ 
h< 
at 
d^ 
di 


SYMPTOMS  EXAMINED   IN   DETAIL. 


98 


cool  down  to  the  ambient  temperature.  A  choleraic 
patient  becomes  as  cold  as  a  subject  dead  several 
hours,  or  even  colder,  and  that  shortly  after  the 
attack;  he  cools  down  while  alive  more  rapidly  than 
does  a  body  which  had  died  of  even  a  lingering 
disease,  or  one  that  has  been  killed. 

122.  Cdd,  This  condition  of  a  choleraic  patient  is 
no  doubt  due,  in  some  degree,  to  the  dark  state  of  the 
blood;  in  other  words,  to  deficient  aeration  of  the  red 
globules,  and  the  diminished  force  with  whicTi  the 
blood,  as  such,  reaches  the  extreme  arteries.  In  cases 
of  arrested  development  of  the  heart,  like  in  puer 
coeruleuSj  the  temperature  of  the  individual  is  always 
less  than  in  those  where  perfect  aeration  takes  place; 
and  such  persons,  when  exposed,  quickly  lose  the 
little  heat  they  possess.  Another  cause  for  reduced 
temperature  is  met  with  in  paralysis.  But  botli 
these  examples  do  not  illustrate  or  explain  the  rapid  ; 
loss  of  caloric  in  a  choleraic  attack.  The  diminished 
or  complete  arrest  of  the  circulation,  even  that  of 
black  blood,  does  not  explain  why,  in  cholera,  the 
body  is  so  soon  cooled  as  it  is.  If  this  were  due  to 
the  diminished  circulation  of  even  black  blood,  the 
length  of  time  the  circuit  takes  to  be  accomplished, 
and  the  number  of  times  this  circuit  must  be  repeated 
before  all  the  blood  completes  the  round,  requires 
more  time  to  reduce  the  temperature  by  this  means 


'.i«= 


•.-V 


J 


94 


ASIATIC   CHOLERA. 


than  it  takes  cholera  to  accomplish  the  task.  A 
choleraic  patient  becomes  cold  in  much  less  time  than 
it  takes  a  dead  body,  from  any  other  cause,  to  cool  to 
the  same  degree.  Besides  that,  a  body  after  ordinary 
death  never  sinks  below  the  temperature  of  the 
atmosphere  and  the  ambient  bodies;  on  the  contrary, 
a  choleraic  patient,  lying  in  on  atmosphere  of  88**  to 
90°,  is  soon  cooled  down  to  less  than  70°  or  68°.  His 
body  is  not  only  colder  than  the  temperature  of  the 
room  he  is  in,  but  the  interior  of  his  body  is  equally 
cold.  This  extraordinary  fact  is  proved  by  his 
expiration  being  as  cold  as  the  air  he  inhaled;  but  ' 
his  stools  are  still  colder,  and  they  come  from  the 
interior  of  his  bowels.       \  :    ^ 

'  123.  During  the  cholera  invasion  of  1832,  in 
Canada,  I  mentioned  this  fact  to  several  practitioners, 
who  seemed  not  to  have  noticed  it,  and  affected  not 
to  credit  my  remark.  It  "'  ^lappened  that  I  was 
called  to  visit  Mr.  Horace  Di..-.  jnson,  aged  45,  on  the 
21st  of  August,  1832,  a  wealthy  gentleman,  living  in 
a  fine  house,  situated  in  a  very  healthy  locality.  He 
had  been  suddenly  attacked,  was  already  in  the 
cyanosed  state,  and  •  purging  still  continued  when  I 
saw  him.  His  family  physician.  Dr.  Robertson,  sat 
on  the  side  of  his  bed,  and  was  in  the  act  of  passing 
napkins  under  him  to  catch  the  evacuations  that  came 
by  gushes.    One  poured  over  his  hands;  he  looked 


.if 


STMPTOMS  EXAMINED  IN  DETAIL 


95 


round  at  me  with  an  air  of  astonislimeut,  and  ex- 
claimed, "  You  are  right;  his  stools  are  quite  cold  1'' 
We  spoke  of  this  occurrence  afterward.  He  said: 
"I  did  not  quite  credit  your  statement  when  you 
made  it,  some  days  ago;  but  now  I  am  convinced  of 
the  reality."  He  went  on  to  remark:  "  How  could 
Buch  large,  gushing  quantities  of  cold  stools  come  out 
of  a  warm  body  ?"  This  is  only  one  instance  of  how 
superficially  many  practitioners  examine  and  reflect 
on  their  cases.  The  body  was  not  only  cold  outside, 
but  cold  throughout  the  viscera.  A  very  little  reflec-  • 
tion  would  have  drawn  attention  to  this  unusual  sub- 
ject,  from  the  fact  of  a  cold  tongue,  a  temperature 
that  could  not  well  be  less  than  that  of  the  head  or 
mouth  that  contained  it;  also,  had  attention  been 
paid  to  the  cold  breath  of  a  patient,  in  contrast  to  a 
warm  breath  breathed  out  in  the  coldest  days  of  a 
Canadian  winter,  while  in  cholera,  even  in  the  hot 
summer  days,  say  88''  to  90®,  it  is  much  below  that  of 
the  inhaled  atmosphere. 

124.  Where  did  this  expired  air  meet  with  its 
reduced  temperature,  if  not  in  the  lungs;  and  if  there, 
how  could  the  lungs  be  colder  than  the  rest  of  the 
interior  of  the  body  ?  These  are  only  two  instances 
indicative  of  the  interior  coldness  of  a  living  body 
of  a  choleraic  patient.  - 


J 


ASIATIC  cnoLERA^tiSmim. 


125.  A  warm  enema  is  soon  returned  cold,  as  has 
been  noticed  by  others  besides  myself. 

136.  But  now  I  must  adduce  a  third,  and  an  irre- 
fragable  proof  of  interior  coldness,  however  start- 
ling the  statement  may  prove  to  the  readers  of  this 
sketch.  To  those  who  are  unacquainted  with  the 
deep  and  perfect  religious  faith  of  the  French  Can- 
adians in  Lower  Canada,  all  Catholics,  what  follows 
may  possibly  appear  extraordinary,  and  perhaps 
censurable;  but  to  a  reasonable  and  generous  minded 
man  all  religions  are  respectable,  and  should  never  be 
trifled  with.  Well,  baptism  is  there  esteemed  es- 
sential to  salvation,  and.  to  an  inheritance  of  the  king- 
dom of  heaven.  Many  pregnant  women,  attacked 
with  cholera — and,  as  repeatedly  said  before,  the 
intellect  of  the  patient  remains  unclouded  to  the  last 
— many  of  these  women,  conscious  of  the  certainty  of 
their  death,  urgently  begged  that  a  Caesarean  operation 
should  be  performed,  in  order  to  save  their  fruit  and 
give  to  it  the  benefit  of  salvation  by  "  infant  baptism." 
Several  practitioners  yielded  to  these  entreaties  and 
operated.  I  was  present  at  a  few  such  operations. 
Although  I  never  once  operated,  I  took  advantage  of 
the  inevitable  opportunity  to  pass  my  hand  into  the 
living  abdomen  among  the  intestines.  In  every  case 
that  I  did  so,  the  viscera  felt  quite  cold.  To  prevent 
any  doubt  from  being  entertained  on  this  point,  I  will 


\ 


■TJ 


SYMPTOMS  EXAMINED  IN   DETAIL. 


97 


givo  the  names  of  some  of  the  operators.  The  first  on 
my  list  is  my  respectable  and  able  colleague  at  the 
time,  Dr.  Pierre  de  Beaubien,  resident  physician,  then 
in  charge  of  the  cholera  hospitals,  one  of  the  most 
assiduous  and  pains-taking  practitioners,  at  his  post 
before  six  o^clock  in  the  morning,  and  who,  by  his 
thorough  anatomical  knowledge  and  numerous  care- 
fully conducted  autopsies,  was  able  to  throw  much 
riegative  light  on  the  pathology  of  cholera.  Dr. 
Beaubien  is  still  a  practitioner  in  Montreal,  and  prin- 
cipal physician  to  the  Hotel  Dieu  Hospital  there.  He,  * 
I  believe,  operated  three  times.  Dr.  John  Stephenson 
(the  first  person  operated  on  for  staphyloraphy,  by 
M.  Roux,  in  Paris)  operated  on  two.  Dr.  Munro,  at 
present  physician,  along  with  Dr.  Beaubien,  at  the 
Hotel  Dieu  Hospital,  operated  about  ten  times,  as  well 
as  I  can  ascertain.  *  Dr.  Robertson  operated  on  one; 
Dr.  Valine  operated  on  six,  to  my  own  knowledge, 
besides  others.  As  the  medical  gentleman  I  have 
named  were,  and  are,  of  the  first  respectability  in 
Montreal,  honorable  and  conscientious  in  their  prac- 
tice, which  was  public,  and  their  doing  necessarily 
made  known  to  my  office  of  Health  Commissioner,  I 
have  felt  it  to  be  no  breach  of  confidence,  but  a  duty, 
to  name  them  while  writing  on  cholera. 

127.  .On  the  27th  of  Oct.,  1865, 1  had  a  conversa- 
tion with  Dr.  Beaubien  on  this  subject.  He  mentioned 


m 


98 


ASUTIO   CHOLERA. 


that  the  foetus  was  dead  in  every  case  he  operated  on, 
unless  it  might  be  one  in  which  Dr.  Munro  assisted 
him,  who  thought  he  did  see  some  slight  indication  of 
a  movement,  but  that  he,  Dr.  Beaubien,  had  doubts  of 
the  fact.  We  can  easily  conceire  the  existence  of  a 
passive  movement  occurring  to  a  foetus  in  removing  it 
from  its  folded  up  position  in  the  uterus;  and  I  may 
add,  without  offering  the  slightest  offense  to  Dr. 
Munro,  that  he  was  at  that  time  a  young  man,  and 
very  zealous,  conditions  that  might  lead  to  error,  in 
the  hope  of  success.  -  >     '      '    ' 

In  justice  to  Dr.  Beaubien  I  must  state  that  he  told 
me  his  Ca8sarean  operations  took  place  in  the  shed 
hospital,  on  women  who  had  just  expired,  or  about  to 
expire;  but  that  he  had  not  operated  on  a  woman 
actually  alive.  In  a  letter  I  have  from  Dr.  Munro,  he 
mentions  having  operated  in  all  thirteen  times,  not 
all  of  them  cholera  cases,  women  on  whom  he  was  in 
attendance  for  the  purpose  of  operating,  and  waited 
to  nearly  the  last  moment  of  life  before  operating. 
As  to  interior  temperature  he  has  no  recollection, 
never  having  given  it  a  thought. 

The  practice  of  Dr.  Valine  was  principally  confined 
to  the  suburbs,  among  the  laboring  classes.  Finding 
that  many  of  the  Caesarean  operations  were  performed 
too  late,  he  was  easily  prevailed  upon  to  operate 
while  the  patient  stiU  lived.    It  was  in  some  of  his 


m. 


BYMPTOMS  EXAMINED  IN  DETAIL. 


99 


in 


cases  I  attended,  at  his  and  Madam  Tayarnior's  re- 
quest, that  I  had  the  opportunity  of  passing  my  hand 
into  the  live  abdomen,  noticing  the  interior  coldness 
of  the  Tiscera  and  that  of  the  foetus.  In  these  cases 
the  funis  was  simply  divided,  and  no  search  made  for 
the  placenta,  and  no  blood  was  discharged. 

128«  On  more  than  one  occasion  I  made  use  of  a 
"  physician's  thermometer;"  inserted  it  into  the  rectum. 
I  also  got  Madam  Tavarnier,  a  celebrated  midwife  in 
Montreal,  to  pass  it  into  the  vagina  of  some  of  the 
patients,  especially  into  that  of  some  of  the  females 
operated  on  by  Dr.  Valine,  at  all  of  whose  operations 
she  assisted.  She  carefully  noted  the  temperature, 
and  made  her  report  to  me.  At  present  I  cannot  give 
a  copy  of  her  report,  which  was  lost,  along  with  many 
of  my  notes,  during  the  political  troubles  of  1837,  etc.; 
but  I  remember  well  that  the  temperature  indicated 
by  the  thermometer  in  vagina  was  lower  than  that  of 
the  atmosphere  at  the  time,  during  some  of  the  hot 
days  of  July  and  August. 

These  operations  will  be  noticed  again  when  treat- 
ing of  a  few  other  curious,  interesting  and  important 
facts  connected  with  this  remarkable  and  still  obscure 
malady.       /.'■•'■•  "-  ■".'■■  c' ■:•*:; 

129.  In  cases  of  saline  injections,  which  were  at  a 
temperature  never  less  than  110°,  at  times  112^,  even 
120^,  and  of  which  injections  a  portion  oozed  into  the 


100 


ASIATIC  CHOLERA. 


intestines  and  camo  away  in  gushes,  these  discharges 
were  cold;  therefore,  the  injection  must  have  lost  its 
high  temperature  in  passing  through  the  interior  of 
the  body. 

I  trust  I  have  adduced  sufficient  proof  that  the 
interior  of  the  body  is  cold,  while  the  patient  is  still 
iiying,  in  cases  of  cholera. 

130.  Vox  cholenca,  or  partial  aphonia.  After 
much  reflection  on  this  symptom  I  have  been  unable 
to  arrive  at  any  satisfactory  explanation.  To  com- 
mence with  the  least  satisfactory  of  my  thoughts  on 
the  subject,  a  mere  idea,  was,  how  far  the  empty  or 
contracted  state  of  the  innominata  and  the  aorta  could 
disturb  the  action  of  the  recurrcnts,  seeing  that  they 
win!  round  these  yessels,  which,  in  health,  are  per- 
manently distended.  I  well  remember  the  case  of  a 
would-be  suicide  who  cut  his  throat,  and  the  left  re- 
current, and  who  lived  a  few  years  after.  His  voice 
was  weak  and  rough,  and  to  produce  it  strong  expira- 
tion was  necessary;  but  still,  in  his  case,  the  voice 
heard  was  not  quite  that  noticed  in  cholera.  The 
next,  and  more  reasonable  explanation,  might  be 
attributed  to  the  altered  state  of  the  lungs,  and  the 
quality  of  the  expired  air.  Another  and  more  likely 
reason  might  be  found  in  the  deposition  of  some  of  the 
choleraic,  pultaceous  matter  in  the  larynx  and  about 
the  vocal  cords;  for  it  was  notuucommoii  to  find  this 


tSYMPTOMB  EXAMINED   IN  DETAIL. 


101 


matter  deposited  in  small  quantity  in  the  trachea. 
These  are  mere  ideas,  only  speculative,  so  that  little, 
if  any,  reliance  can  bo  placed  upon  them. 

131.  Perverted  sensation  of  heat  on  the  surface  and 
in  the  stomach  is  constantly  present  in  every  case, 
while,  in  every  other  respect,  all  other  sensations, 
as  hearing,  sight,  smell  and  taste  are  natural,  with  an 
undisturbed  intellect.  This  cannot  be  explained  by 
any  known  physiological  theory,  or  even  by  the 
wildest  speculations  of  would-be  physiologists.  We 
must  remain  satisfied  with  the  fact,  and  not  presume 
to  explain  that  which  is  not  given  to  us  to  know. 

132.  Cramps,  Can  the  cold  state  of  the  patient, 
and  the  vacuity  or  uselessness  of  the  arterial  system, 
be  related  to  their  production  ?  It  is  well  known 
that  many  persons  past  thirty  years  of  age  will  be 
seized  with  cramp  in  a  foot  or  leg  when  lying  down, 
and  cold  at  the  time.  Another  well  known  fact  is, 
that  after  great  and  rapid  loss  of  blood,  or  other 
quick  drain  from  the  body,  cramps  are  not  uncom- 
mon. No  doubt  there  is  some  other  influence  in  their 
production  Ihan  these  now  mentioned.  A  few  writers 
on  Asiatic  cholera  state  cramps  as  pathognomonic, 
even  in  slight  cases.  But  there  are  many  cases 
wherein  this  symptom  has  been  absent,  and  they  do 
not  occur  in  children.  .        _ 

133.  Urinef  suppression  of.    It  is  easy  to  account 


E  I 


102 


ASIATIC   CHOLERA. 


for  this  symptom.  Vomiting,  purging  and  transuda- 
tion havo  completely  drained  the  system,  and  what- 
ever fluid  may  have  been  taken  in  is  almost  as  soon 
rejected,  and  none  remains  long  enough  in  the  stom- 
ach to  be  absorbed  into  the  circulation  to  fill  up  the 
deficiency,  even  if  absorption  could  take  place  in  the 
cyanosed  state  of  cholera;  the  arterial  system  is 
empty  and  cannot  be  replenished  for  the  reasons  just 
stated;  besides,  it  is  doubtful  whether  the  impulse  of 
the  heart  can  drive  the  little  vitiated  blood  within  its 
power  as  far  as  to  the  extremities  of  the  emulgent  ar- 
teries; if  this  do  not  take  place  urine  cannot  be  gener-  I 
ated.  It  is  generally  said  that  secretion  is  derived 
from  the  blood;  but  this  is  a  loose  assertion,  repeated 
by  routinists,  who  seem  not  to  be  aware  that  the  ar- 
teries are  common  carriers  of  blood  and  the  fluids 
poured  into  them  by  the  process  of  ingestion;  but  it 
is  not  from  the  blood,  as  such,  that  the  materials  of 
secretions  are  derived;  it  is  had  from  the  heteroge- 
neous materials  added  to  it.  This  is  not  the  place 
to  discuss  these  facts,  which  I  have  exposed  many 
years  since.  Since  there  is  neither  material  to  fur- 
nish secretion,  nor  circulation  to  carry  the  material 
to  the  secretive  organ,  none  can  take  place,  and,  of 
course,  the  bladder  remains  empty.  .^ 

134.  It  is  stated  that  urea  is  found  in  the  blood; 
there  is  nothing  remarkable  in  this,  that  a  compound 


SYMPTOMS  EXAMINED  IN  DETAIL. 


103 


clement  should  bo  found  in  small  quantity  In  tho 
blood  that  remains,  since  it  is  unknown  in  what  way 
tho  choleraic  poison  affects  tho  chomical  compononts 
of  the  tissues  and  fluids,  and  might  eparo  this  ele- 
ment, while  by  its  mutation  of  ordinary  compound 
elements  into  others  of  a  different  quality,  only  dif- 
ferently grouped,  without  losing  or  gaining  a  simple 
atom.  One  or  two  analyists  have  said  that  the  quan- 
tity is  great;  no  doubt,  if  it  be  spared  at  all,  being 
found  in  blood  greatly  diminished  in  volume,  tho 
quantity  would  be  dispioportionod  and  appear  large. 
Some  persons  may  make  this  objection — since  cholera 
permits  the  complete  escape  of  the  salts  vi  tho  blood, 
why  not  urea  also  7  The  salts  that  do  escape  are 
mineral,  while  urea  is  a  created  body  out  of  organic, 
not  mineral,  matter. 

135.  Strangury^  as  it  is  often  called  in  those  cases 
of  ischuria,  is  almost  a  constant  occurrence  in  male 
patients,  a  ceaseless  but  ineffectual  desire  to  urinate; 
and  I  have  known  a  busybody  practitioner  introduce 
a  catheter  to  draw  off  what  urine  ho  supposed  was  in 
the  bladder;  of  course,  he  found  none.  For  nearly  the 
three  or  four  first  weeks'  continuation  of  cholera,  I 
was  unable  to  imagine  what  was  the  cause  of  this 
distressing  symptom.  At  last  I  unexpectedly  dis- 
covered it,  a  most  simple  one,  which  I  shall  now 
describe.   It  is  easy  to  get  a  good  view  of  the  pelvis 


M 


;'V- 


1C4 


ASIATIC   CHOLERA. 


Y 


in  a  cholera  subject,  since  the  intestines  are  all 
empty,  and  take  up  but  little  space.  They  can  be 
lifted  or  moved  out  of  the  pelvis;  this  affords  a  good 
view  of  the  urinary  bladder.  But,  first,  there  are 
these  who  suppose  that  in  the  operation  of  discharg- 
ing the  bladder  it  contracts  in  dR  directions  down  to 
almost  complete  vacuity.  This  is  an  error  that 
lithotomists  ought  to  know,  even  those  practitioners 
who  frequently  draw  off  the  urine  with  a  catheter. 
Now,  the  base  of  the  bladder  lies  against  the  floor  of 
the  pelvis,  between  the  back  of  the  pubis  and  the 
front  of  the  rectum,  in  the  male,  where  it  is  tied  down 
to  this  floor,  and  is  never  removed  thence,  however 
much  the  viscus  may  be  distended  with  urine;  here  it 
forms  a  jiat^  adherent  disc,  about  two  or  two  and  a 
half  inches  in  diameter,  from  side  to  side,  and  from 
before  backwards  between  the  pubis  and  rectum;  in 
t  he  very  centre  of  this  disc  the  urethra  opens.  When 
t  he  bladder  expands  by  accumulation  of  urine,  it  is 
the  sides  and  summit  that  expand,  and  a  portion  of 
the  base  also  stretches  to  some  extent,  but  the  base 
never  leaves  its  attachment  to  the  floor  of  the  pelvis, 
to  which  it  is  aflfixed  by  pretty  close  cellular  tissue. 
When  the  bladder  is  empty  all  contracts,  the  summit 
and  sides  as  far  as  to  the  lateral  limits  of  the  base 
disc,  and  in  this  state  the  summit  of  the  bladder 
forms  another  disc,  of  equal  dimensions  to  the  base 


t        II 


SYMPTOMS  EXAMINED   IN  DETAIL. 


105 


one,  and  comes  into  immediate  flat  contact  with  the 
lower  one.  If,  now,  the  intestines  be  pushed  away, 
on  looking  into  the  pelvis,  this  summit  will  come  into 
distinct  view,  with  a  depression  in  the  centre,  like  an 
umbilicus,  corresponding  to  the  internal  meatus  that 
perforates  the  base  disc.  Let  the  anatomist,  with  a 
curved  scissors,  cut  into  the  bladder  all  around  the 
point  of  meeting  of  the  two  discs  so  as  to  separate 
them,  and  by  taking  the  edge  of  the  upper  disc  with 
a  forceps  gently  pull  it  away  from  the  lower  one; 
he  will  find  that  the  umbilicated  depression  is  pro- 
duced by  J,  portion  of  the  summit  being  forced  info 
the  meatus,  acting  in  the  latter  like  a  foreign  body, 
and  creating  the  sensation  of  micturition.  If  this 
dissection  be  well  conducted,  on  taking  hold  of  one 
limb  of  the  upper  disc,  and  gradually  drawing  it 
away,  it  will  be  noticed  that  some  little  force  is  re- 
quisite to  draw  the  invaginated  portion  out  of  the 
meatus.  The  complaint  of  incessant  desire  to 
urinate  is  most  noticeable  in  those  cases  that  have 
been  accompanied  with  violent  vomiting  and  abdomi- 
nal contractions,  along  with  gastric  cramps,  for  it  is 
these  compressions  that  force  the  viscera  against  the 
summit  of  the  bladder  and  press  its  centre  into  the 
meatus. 

136.  Females  escape  this  accident,  by  reason  of 
the  different  mode  of  attachment  of  the  bladder,  a 


■>5 


II 


106 


ASIATIC   CHOLERA. 


considerable  portion  of  which  lies  against  the  anterior 
surface  of  the  uterus  and  anterior  face  of  the  vagina. 

I  trust  I  have  not  uselessly  wearied  the  patience  of 
the  reader  in  this  long  detail;  for  I  confess  that, 
until  I  discovered  this  fact,  I  had  not  a  very  accurate 
notion  of  the  extent  of  the  attachment  of  the  bladder, 
although  I  had  often  dissected  these  parts,  and  had 
many  times  performed  lithotomy. 

137.  Transpiration.  The  discharge  through  the 
skin,  could  it  all  be  collected,  would  amount  to 
many  pounds.  It  commences  almost  at  the  onset 
of  the  attack,  and  is  always  as  cold  as  the  sur- 
rounding atmosphere;  in  a  hot  summer  day  of  90° 
ij;  is  colder  than  the  atmosphere  and  the  furniture  of 
the  room.  Most  writers  on  cholera  use  the  word 
"  perspiration;"  but  perspiration,  like  secretion,  has 
no  existence  during  an  attack  of  cholera.  The  dis- 
charge through  the  skin  is  not  brought  to  this  exten- 
sive organ  by  the  extreme  arteries  for  the  impulse 
of  the  heart  does  not  reach  so  far;  all  is  stagnation. 

To  account  for  this  great  oozing  through  the  skin, 
as  well  as  that  which  is  poured  into  the  alimen- 
tary canal,  both  fluids  being  of  the  same  quality, 
search  must  be  directed  elsewhere  than  to  the  vas- 
cular system,  the  operation  of  which  is  arrested  in 
cholera.  Writers  on  cholera  say  that  these  fluids 
consist   of  the  serous  parta  of  the  blood,  the  red 


'.■\ 


STMPTOMS  EXAMINED  IN  DETAIL 


107 


obules  and  part  of  the  fibrin  being  left;  but  this 
ioes  not  explain  the  whole  loss,  nor  how  this  serous 
fluid  reached  the  surfaces  to  pass  out,  for  neither  the 
absorbents,  the  veins  or  arteries  act;  nor  does  the 
assertion  (for  it  is  merely  an  assertion)  demonstrate 
that  the  "  rice  water"  matter  consists  of  serum,  as 
such,  and  of  fibrin^  to  which  two  bodies  it  has  not  t];^o 
slightest  resemblance;  nor  can  organic  chemistry 
prove  any  thing  beyond  the  simple  fact  that  it  is 
animal  matter,  reducible  by  analysis  to  C.  H.  0.  N. 
in  special  proportions,  besides  containing  a  few  salts 
that  are  always  present  in  the  blood,  and  the  tissues 
outside  of  the  blood. 

It  is  possessed  of  peculiar  properties  that  are  not 
found  in  any  known  secretions  derived  from  the  tor- 
rent of  the  circulation.  It  freely  arrives  at  the 
cutaaeous  and  intestinal  surfaces  and  permeates  them 
to  escape  from  the  system;  but  it  never  passes  through 
the  serous  membranes,  since  none  is  ever  found  in  the 
peritoneal,  pleural,  or  arachnoid  cavities.  None  is 
ever  met  with  in  the  urinary  or  gall  bladders,  but 
some  is  occasionally  found  in  the  bronchi  in  small 
quantity.  Whence,  then,  does  this  peculiar  fluid 
come,  and  from  what  is  it  produced  ?  are  important 
questions. 

13,8.  Catalysis  is  the  only  theory  which,  to  mo, 
appears  capable  of  rendering  an  explanation.    The 


■A 


sm:i 


/^V 


> 


108 


'  "  ASIATIC   CHOLERA.       ' 


cholera  poison,  whatever  it  may  be,  and  however  it 
may  enter  the  body,  soon  acts  on  the  juices  combined 
with  the  tissues,  and  which,  by  a  simple  mutation  of 
the  numerical  proportions  that  constitute  the  com- 
pound elements  which  make  up  the  diflferent  elements 
of  the  body,  creates  another  set  of  compound  elements 
which  is  fluid,  and  has  the  property  of  freely  passing 
through  the  tissues  to  reach  the  outward  surfaces  and 
escape,  dispensing  with  the  services  of  the  absorbent 
and  arterial  systems. 

139.  Bile.  The  gall  bladder  is  always  distended 
with  natural  looking  bile,  in  every  case,  and  the  duc- 
tus communis  choledocus  and  the  ductus  hapatictis  are 
both  perfectly  open  and  unobstructed  in  their  whole 
length.  How  the  bile  remains  in  its  bladder  and  is 
not  forced  out  into  the  duodenum  and  pumped  into 
the  stomach  by  the  violent  vomiting  of  the  patient, 
and  the  strong  contractions  of  the  abdominal  walls 
compressing  the  cyst,  baffles  explanation.;  for,  in 
ordinary  vomiting,  bile  is  always,  towards  the  last, 
forced  more  or  less  into  the  stomach;  while  in  chol- 
era an  invariable  characteristic  is  that,  during  the 
whole  duration  of  the  attack,  no  bile  is  ever  dis- 
charged, none  even  after  the  acute  stage  has  termi- 
nated and  a  return  towards  health  has  commenced. 

However,  the  presence  of  bile  in  the  gall  bladder 
after  arterial  action  has  mostly  ceased,  need  cause  no 


\ 


•,-\\ 


SYMPTOMS  EXAMINED  IN  DETAIL. 


109 


surprise,  since  bile  is  the  product  of  the  splanchnic 
veins,  and  the  liver,  like  many  other  portions  of  the 
system,  continues  to  act  after  animal  death.  But 
that  which  remains  unexplained  is,  how  is  it  re- 
tained? 

110.  Leaden  color,  blue  or  cyanosed  skin,  appears 
simple  enough.  A  portion  of  the  venous  black  blood, 
and,  perhaps,  a  little  furnished  by  the  non-aerated 
arterial  blood  is  not  returned  to  the  great  vessels  and 
heart,  but  lies  stagnant  in  the  rete  malpighi  of  ibe 
skin,  also  among  the  vessels,  and  gives  a  very  dark 
color  to  the  abdominal  viscera,  as  is  seen  in  Cassarean 
section,  and  which,  seen  in  the  abdomen,  some  wri- 
ters have  called  congestion,  a  convenient  word;  but 
whether  the  blood,  so  stagnant,  consists  of  globules 
escaped  through  the  parieties  of  the  vessels  as  whole 
globules,  or  is  haematin,  separated  from  broken  up 
globules,  is  not  yet  deafly  known. 

111,  In  rapid  cases,  such  as  recover  in  twenty- 
four  hours  or  less,  the  blue  color  almost  as  soon  dis- 
appears, or  nearly  so;  but,  in  cases  that  linger 
longer,  the  skin  remains  dark  for  several  days,  the 
blue  color  gradually  changing  to  a  dirty  red,  less  and 
less  so  daily.  However,  some  of  the  dusky  red  tint 
will  be  perceptible  as  late  as  the  tenth  day,  as  I  saw 
in  the  case  of  a  very  fair  skinned  lady,  who  then  died, 

6 


Ni 


110 


ASIATIC   CHOLERA. 


exhausted,  in  that  state  which  has  been  erroneously 
called  typhoid. 

143.  Mental  faculties.  During  the  whole  of  this 
wonderful  commotion  in  the  economy  it  is  exceedingly 
interesting  to  notice  that  the  mental  faculties  suffer 
only  one  aberration — an  erroneous  sensation,  of  heat, 
while  all  is  preternaturally  cold;  in  all  other  respects 
the  judgment  remains  perfectly  sound  and  unclouded, 
so  much  so  that  the  remark  has  been  made  within  my 
hearing  in  regard  to  a  weak  minded  or  trivial  person 
while  healthy,  that  such  an  one  has  now  sober  senses 
for  the  first  time. 

Routine  physiologists  insist  that  the  manifesta- 
tions of  mind  from  the  brain  require  a  full  supply 
of  healthy  arterial  blood;  but  in  cholera  the  blood 
sent  to  the  brain  is  disordered  blood,  and  the  quantity 
passing  through  it,  like  all  over  else,  is  much  dimin- 
ished. Verily,  this  disorder  contests  many  opinions 
that  have  been  handed  down  as  true  and  promulgated 
as  essential  to  animal  existence. 

143.  Thirst,  This  is  not  due  to  fever,  to  inflam- 
mation, or  to  an  excessive  amount  of  salt  in  the  blood, 
as  a  meal  of  salted  food  will  excite  the  salt  blood, 
calling  for  dilution ;  not  due  to  fever,  for  there  never 
is  any;  nor  is  it  like  the  thirst  that  follows  rapid  loss 
of  blood,  and  which  is  a  voice  calling  for  repletion. 
The  cholera  thirst  quickly  follows,  almost  precedes, 


SYMPTOMS  EXAMINED  IN  DETAIL. 


it 


the  first  evacuations,  lasts  until  the  attack  has  ceased, 
even  during  the  "  typhoid  state,"  for  several  days, 
growing  less  and  less  urgent  as  the  system  becomes 
replenished.  It  is  the  most  urgent,  constant  and  dis- 
tressing symptom;  the  craving  for  vrater,  cold  water, 
is  incessant,  and  is  no  sooner  drank  than  it  is  thrown 
up  again,  and  more  is  called  for;  so  irritable  is  the 
stomach,  it  does  not  remain  long  enough  to  be  ab- 
sorbed,  even  if  absorption  existed,  which  is  not  the 
case  in  the  cyanosed  state.  This  thirst  is  due  to  the 
great  and  rapid  loss  of  fluid  the  system  has  suffered, 
and  the  craving  is  more  the  voice  of  nature  than  that 
of  the  patient,  ever  crying  aloud,  lam  empty ^  fill  me; 
and  the  cry  will  continue  until  the  depleted  system  is 
restored  to  its  usual  state. 

We  have  now  come  to  the  end  of  the  critical 
examinations  of  the  phenomena  ever  present  in 
cholera — ^it  is  hoped  not  without  exciting  some  in- 
terest in  the  reader. 


% 


m 


i>. 


vi 


CHAPTER  V. 

ITINERARY  IN  CANADA. 

Departure  of  cholera  from  Great  Britain,  its  ar- 
rival in  Canada  being  the  introduction  of  a  new  pest 
into  a  new  country.  At  the  close  of  Chapter  I.  it 
was  said,  "  we  shall  trace  it,  led,  as  it  were,  by  the 
hand,  across  the  ocean  into  the  New  World," 

144.  By  direction  from  the  Colonial  Office,  Lon- 
don, the  Governor,  Lord  Aylmer,  sent  a  message  to 
the  House  of  Assembly,  February  3d,  1832,  recom- 
mending that  a  bill  should  be  passed  for  quarantine 
and  health  purposes.  About  the  25th,  the  bill  was 
reported  and  passed.  It  was  the  first  sanitary  and 
quarantine  measure  ever  enacted  in  Canada.  It  em- 
powered the  Governor  to  name  a  Board  of  Health,  to 
consist  of  senior  magistrates,  a  Health  Commissioner, 
a  Resident  Physician,  establish  a  quarantine  station 
at  Grosse  Isle,  below  Quebec.  This  act  possessed  two 
great  merits:  1st,  it  was  short;  2d,  the  Governor  was 
to  make  the  appointments,  and  could,  of  course,  dis- 
place his  appointees  at  pleasure. 


ITINERARY  IN  CANADA. 


113 


145.  Grosse  Isle  was  an  excellent  station,  an 
island,  that  could  not  be  reached  without  permission, 
and  had  safe  ports  and  good  anchorage.  Here  he 
established  a  military  post,  with  officers  to  command, 
and  a  small  battery  to  enforce  obedience  to  passing 
vesselsj  the  Resident  Physician  on  the  island  to  at- 
tend to  the  sick;  and  the  Health  Commissioner  was 
executive  officer.  Dr.  Griffin,  surgeon  of  the  23d  regi- 
ment, was  appointed  to  the  latter  office;  being  a  mili- 
tary man,  ho  was  habituated  to  system,  method  and 
obedience,  and  to  enforce  the  same.  But  his  office 
was  a  new  one,  created  in  a  hurry,  and  not  well 
organized  for  some  time.  He  took  possession  of  his 
post  on  April  23d,  only  ten  days  before  the  merchant 
fleet  came  rushing  in,  this  year  later  than  usual.  On 
the  1st  May  snow  fell  and  covered  the  country  "  in 
the  white  robes  of  Winter." 

146.  A  similar  Board  of  Health  was  created  for 
the  cities  of  Quebec  and  Montreal.  The  civil  magis- 
trates put  on  these  boards  were  relied  upon  by  the 
public  as  gentlemen  of  character  and  honor,  and  not 
place-holders.  They  simply  gave  countenance  to  the 
Executive  of  the  Board,  and  never  introduced  im- 
pertinent interference  in  any  district.  Quebec  was 
not  quite  as  well  oflf  as  Montreal,  because  the  great 
importing  merchants  and  consignees  of  vessels  could 
exercise  some, unseen  control,  while  Montreal  escaped 


%,   ; 


1 


if. 


1 


fi 


114 


ASIATIC  OROLBRA. 


this,  seeing  that  vcssols  which  arrived  here   had 
passed  through  all  necessary  supervision.  <  '• 

147.  Shipping  from  Great  Britain  endeavors  to 
leave  towards  the  end  of  March,  so  as  to  pass  into 
the  gulf  and  up  the  St.  Lawrence  before  the  desdend- 
ing  ice  accumulates  to  bar  their  passage.  In  1831, 
the  first  arrivals  at  Quebec  were  as  early  as  April 
24th;  but  in  1832  this  fleet  was  caught  in  the  ice  of 
the  gulf  April  20th,  and  some  of  the  vessels  choked 
therein  for  fifteen  to  eighteen  days  before  working 
through;  the  first  did  not  reach  Grosse  Isle  before 
the  3d  May.  Let  us  stop  here  for  a  few  moments  to  i 
notice  the  departures  of  vessels  from  the  ports  of 
Great  Britain  and  Ireland,  infected  places. 

148.  The  Robert,  from  Cork,  now  at  Grosse  Isle, 
14th  May,  a  few  days  out,  with  passengers,  had  10 
deaths,  the  last  one  on  the  28d  April.  Seven  of  the 
ten  died  of  common  cholera;  three  of  Asiatic  cholera. 

Gonstantia,  from  Limerick,  28th  April,  170  emi- 
grants, lost  29  in  fifteen  days;  3  of  Asiatic  cholera, 
11  common  cholera,  the  rest  diarrhcea. 

Elizabeth,  from  Dublin,  May  28th,  200  emigrants, 
lost  22;  2  of  Asiatic  cholera,  11  common  cholera,  and 
5  of  diarrhoea,  a  few  days  out. 

Carrick,  from  Dublin,  arrived  at  Grosse  Isle  June 
3d;  lost  42  in  the  first  fifteen  days  out;  all  well  on 
arrival. 


ITINERABT  IK  CANADA. 


115 


Brig  Brutus,  from  Cork,  270  emigrants,  in  a  few 
days  had  many  deaths;  after  that  all  well. 

Ship  Brutus,  from  Liverpool,  18th  May,  3^0  pas- 
sengers, mostly  people  from  the  agricultural  districts. 
On  the  28th,  in  the  morning,  all  were  well.  In  the 
afternoon  had  one  man  and  one  child  attacked,  and 
died.  On  Tuesday  death  made  fearful  ravages.  On 
Saturday  threw  13  overboard.  On  Monday  the 
mate,  steward  and  cook  took  ill.  Captain  made  for 
Cork,  but  went  into  Liverpool.  Total  deaths  since 
cholera  broke  out,  81.  The  foregoing  are  not 
selected  instances  of  cholera  breaking  out  on  ship- 
board shortly  after  sailing  for  Canada,  but  were 
taken  promiscuously  from  among  many.  It  will  at 
once  strike  the  reader  how  similar  are  these  facts  to 
those  already  mentioned  as  attacking  the  British 
shipping  in  India,  and  the  two  French  frigates  after 
leaving  Manilla.  The  reader  will  not  fail  to  notice 
the  glaring  attempt  at  deception  practiced  by  the 
captains  on  the  quarantine  authorities;  such  as,  "the 
Elizabeth  lost  22,  only  two  of  which  were  of  Asiatic, 
and  11  were  of  common  cholera,  and  5  of  diarrhoea" 
— ^nothing  is  said  of  the  remaining  4.  Where  did  the 
veracious  captain  acquire  his  great  diagnostic  knowl- 
edge between  Asiatic  and  common  cholera  ? 

The  Carrick,  from  Dublin,  lost  42  in  the  first  fifteen 


■m 


A\ 


116 


ASIATIC   CHOLERA, 


days;  after  that  all  was  well,  until  arrived  at  Grosse 
Isle,  Juno  3d,  when  one  woman  was  attacked. 

The  brig  and  the  sliip  Brutus  each  speaks  in  the 
same  way  for  itself. 

The  Elizabeth  lost  22,  of  which  2  were  of  Asiatic 
and  11  of  common  cholera:  what  a  knowing  captain! 
But  we  have  all  heard  of  "  sea  "  invoices  being  made 
by  captains  of  vessels  to  suit  emergencies. 

149.  It  was  said  that  "  we  shall  trace  cholera  i'rom 
England,  the  leap-off  point  in  Europe,  acio.^s  the 
ocean  into  Canada.^'  It  is  hoped  that  the  siiipping 
cases,  just  referred  to,  will  suffice  to  establish  that 
point.  And  that  they  will  confirm  what  was  said, 
Sec.  88,  that  on  ship-board  cholera  would  attack  the 
crew  and  passengers  in  a  short  time,  as  early  as 
twenty-four  hours  after  leaving  port,  seldom  later; 
and  by  the  third  or  fourth  day  nearly  all  on  board 
susceptible  of  the  pestilence  would  be  down  with  the 
malady;  that  by  the  end  of  ten  days,  or  two  weeks 
at  most,  scarcely  a  new  case  would  happen.  But  when 
the  ship  would  reach  her  destination,  and  her  people 
get  on  shore,  some  who  had  escaped  while  on  board 
might,  in  a  new  atmosphere,  be  attacked;  and  the 
weU  passenger  would  infect  of  thos^  *^h&y  ap- 

proached, as  was  the  case  Hh  ikauriiiua. 

Quarantine  station  of  Grosse  Isle  received  ships 
from  British  infected  ports  early  in  May,  some  of  which 


'•  '"•. 


ITINERARY  IN   CANADA. 


117 


vessels  11  ad  had  cholera  shortly  after  leaving  the 
iufoctod  porf,  and  the  post  waH  hooii  over  on  Ixmrd. 
Those  VL.ssols  reach^^rd  the  quarantine  all  well.  They 
were,  however,  detained  for  a  few  dayn,  the  p€  wngors 
sent  on  shore,  thcv  and  the  vessel  well  flconsed  and 
thoroughly  aired,  after  which  they  were  permitted  t< 
go  to  the  end  of  the  voyago,  Quebec, 

150.  It  is  curious  to  obt^erve  Ihat  the  pest  did  not 
appear  in  Quebec,  the  first  Htoppiug  place,  for  the 
space  of  an  entire  month,  although  several  hundrer' 
ships  moored  there,  and  many  thousand  pass  nger^ 
had  debarked.  The  first  appeuranre  of  cholera  took 
place  Friday,  the  8th  June,  as  v  is  made  public  by  the 
Quebec  Mercury  of  Saturday,  tlie  Otij.  "  Since  yester- 
day morning  eight  cases  have  occurred  and  three 
deaths,  and  two  others  despaired  (  f.  This  disease  first 
appeared  in  a  boarding  house  in  C^hamplain  street,  a 
narrow  street  between  the  base  of  the  cape  and  the 
port,  kept  by  Roach.  The  patients  are  emigrants,  a  nd 
said  to  be  some  of  those  landed  on  Thursday  evening 
from  the  steamer  Voyageur,  8  p.m.  Fifteen  cases 
have  appeared  since  yesterday  morning,  seven  of  whom 
have  died." 

15i.  This  account  is  defective,  in  n"t  stating  where 

the  Voyageur  picked  up  her  passengers;  but  as  there 

was  no  intermediate  place  between  Quebec  and  Grosse 

Isle  where  any  passengers  GOuld  be  had,  we  are  forced 

6* 


118 


ASIATIC  CHOLEBA. 


to  suppose  that  she  got  them  at  Grosse  Isle,  either 
openly  or  clandestinely.  The  dates  of  the  arrival  of 
the  Carrick  at  quarantine  on  the  3d,  and  the  out- 
break in  Ghamplain  street  on  the  8th,  are  sufficiently 
precise  to  fix  the  importation  of  the  pestilence  on  the 
Carrick. 

All  the  newspapers  that  pander  to  the  merchants 
for  support  at  once  railed  out  against  the  Mercury 
for  creating  "unnecessary"  alarm.  One  paper  said; 
"  The  Mercury  is  censurable  for  spreading  such  a  re- 
port, creating  an  alarm  that  must  affect  commerce  over 
the  continent  of  America,  and  will  prevent  the  summer 
influx  of  pleasure  seekers  from  the  U.  S.,  who  spend 
large  sums  of  money  in  our  cities."  In  consequence 
of  the  alarm  so  excited  Dr.  Morin,  Health  Commis- 
sioner at  Quebec,  and  T.  A.  Young,  Esq.,  Secretary  of 
the  Board  of  Health,  went  down  to  Grosse  Isle  to 
ascertain  all  the  particulars  respecting  the  crew  and 
passengers  of  the  Carrick.  They  made  the  follow- 
ing report: 

162.  "Board  op  Health,  Quebec,  June  8, 1832. 
Various  reports  having  been  circulated  that  a  vessel 
had  arrived  at  Grosse  Isle  in  which  there  were  several 
persons  ill  of  Asiatic  cholera,  public  notice  is  Jereby 
given  that  the  Health  Commissioner,  having  pro- 
ceeded to  Grosse  Island,  by  order  of  the  Board  of 
Health,  has  reported  that  the  brig  Carrick,  James 


ITINEBABT  IN  CANADA. 


119 


u 


Hudson,  master,  from  Dublin,  arrived  at  quarantine 
on  the  3d  instant;  that  there  were  on  board  133 
passengers,  all  of  whom  had  been  landed,  and  are  in 
the  Emigrant  Shed;  that  the  vessel  is  undergoing  the 
usual  process  of  disinfection;  and  that  at  the  time  of 
his  departure,  on  the  evening  of  the  7th,  there  was 
not  a  case  of  Asiatic  cholera  on  the  island.  By  order 
of  the  Board  of  Health.    T.  A.  Young,  Secretary." 

153.  This  proclamation  from  the  Board  of  Health 
is  so  studiously  obscure  that  it  excited  doubts  regard- 
ing the  honesty  of  the  signers,  and  increased  the  pre- 
vailing alarm  instead  of  quieting  it.  It  was  in  con- 
sequence of  rumors  of  the  existence  of  cholera  that 
the  Commissioner  went  to  Grosse  Isle,  returned  and 
made  this  ambiguous  report,  but  not  a  word  is  said 
of  what  actually  existed  in  the  city  1  In  a  day  or  two 
more  the  pestilence  had  spread  so  widely  that  disguise 
could  no  longer  be  maintained,  and,  as  a  substitute, 
the  cry  was  spread,  "  Cholera  is  not  contagious,  it  is 
merely  in  the  air,  etc.  Let  not  the  people  be  alarmed; 
attend  to  business  as  usual;  live  frugally  and  tem- 
perately; observe  great  cleanliness.  It  is  only  the 
reckless,  intemperate  and  drunkards  that  suffer." 
Abominable  falsehoods  like  this  were  daily  repeated 
for  a  while,  and  even  announced  from  the  pulpit, 
notwithstanding  it  was  notorious  that  the  affluent 
and  most  respectable  members  of  society  died  daily. 


f  1 


■III 


120 


ASIATIC   CHOLERA. 


Members  of  Parliament,  magistrates,  wealthy  retired 
gentlemen,  living  in  their  own  sumptuous  houses,  on 
their  own  property,  in  select  places  as  to  salubrity, 
were  attacked  and  died  as  early  as  the  poor  and  the 
profligate,  and  in  a  statistical  proportion  greater  than 
that  of  the  poor.  Still  the  would-be  moralizers  and 
teachers  of  society  did  not  perceive  that  they  were  all 
this  time  calumniating  the  character  of  the  best  men, 
even  their  friends,  who  filled  the  highest  stations. 

16i.  The  first  cases  of  cholera  that  broke  out  in 
Canada  happened  in  an  emigrant  house  kept  by  the 
man  Roach,  on  the  noon  of  June  the  8th,  among 
passengers  brought  there  by  the  steamer  Voyageur. 
This  same  steamer  carried  a  load  of  emigrants  from 
Quebec  to  Montreal,  and  arrived  at  the  latter  place 
late  in  the  afternoon  of  the  9th.  At  once  the  pas- 
sengers crowded  upon  the  wharf  with  their  trunks 
and  baggage.  They  managed  to  get  away  in  a  short 
time  to  the  entrance  of  the  Lachine  Canal,  in  the 
Ste.  Anne  suburbs.  When  the  wharf  became  clear  of 
the  incumbrance,  a  man  was  seen  lying  on  his  back, 
dying.  I  happened  to  be  passing  at  that  moment, 
and  took  a  look  at  him.  I  had  him  carted  to  the 
Roman  Catholic  dead-house.  Here  he  was  seen  by  four 
other  medical  men,  one  of  whom,  Dr.  T.  Arnoldi, 
opened  a  vein,  and  by  much  squeezing  and  kneading 
of  the  arm  about  a  tablespoonful   of  very  black, 


t 

n 


/. 


ITINEBAST  IN  CANADA. 


121 


thick,  cold  blood  was  obtained.    He  soon  died.    We 
never  could  ascertain  who  he  was. 

155.  Among  the  departed  was  an  Irish  family. 
They  took  lodgings  in  the  upper  room  of  a  neat, 
clean  and  small  hotel  near  the  port.    A  soldier  in  the 
garrison  was  related  to  them;  he  got  leave  to  spend 
the  night  with  these  his  people.     About  8  a.m.,  Sun- 
day, the  10th  June,  I  was  sent  for.    I  found  a  woman 
and  a  man  of  those  arrived  the  preceding  evening 
dead,  and  the  soldier  blue  and  dying.     He  was  at 
once  removed  to  the  garrison,  and  was  the  first  case 
of  death  from  cholera  that  occurred  there.    This 
statement  is  remarkable  in  several  points :  1st,  the 
steamer  that  carried  the  first  cases  of  cholera  to 
Quebec  was  the  same  pest  ship  that  brought  these 
cases  to  Montreal  and  landed  the  dying  man  on  the 
wharf;  2d,  while  there  is  nothing  unusual  for  cholera 
to  break  out  among  persons  who  had  gone  through 
previous    exposure,  but  who,  on  reaching  a   new 
atmosphere  (Sec.  149)  should  be  attacked,  there  is, 
3d,  the  sudden  and  astounding  invasion  of  a  healthy, 
vigorous    man,  the  soldier,  that    had  never  been 
exposed  before,  and  who  was  attacked  and  died  in 
about  12  hours.    4th.  The  time  from  the  outbreak  in 
Quebec  to  that  in  Montreal  was  barely  thirty  hours. 
5th'.  The  distance  between  Quebec  and  Montreal  is 
about  200  miles,  and  over  this  long  distance,  thickly 


t . 


t  ■■ 


\> 


122 


ASIATIC    CHOLERA. 


inhabited  on  both  shores  of  the  St.  Lawrence,  cholera 
made  a  single  leap,  without  infecting  a  single  village 
or  a  single  house  between  the  two  cities  —the  houses 
all  along  the  distance  not  over  one  to  two  acres 
apart.  Theorists  said  that  cholera  traveled  in  the 
air — was  not  given  out  by  the  patient.  In  such  a 
case  as  this  the  air  must  have  been  very  capricious. 

156.  On  my  return  to  breakfast  after  visiting  the 
patients  in  the  hotel,  a  messenger  was  waiting  for 
me  to  go  to  a  man  in  Sanguinette  street,  St.  Lawrence 
suburbs.  There  I  found  an  old  laboring  man  lying 
at  the  point  of  death,  his  bed,  as  usual,  among  the 
French  Canadians,  surrounded  by  women  kneeling, 
repeating  the  litany  for  the  dying.  He  was  blue, 
cold,  and  soon  died.  He  went  to  bed  quite  well;  was 
awakened  about  midnight,  with  vomiting  and  purg- 
ing. On  leaving  this  house  I  was  met  by  a  mes- 
senger, who  requested  me  to  go  to  St.  Constant 
street.  Here  I  found  another  man,  like  the  last  one, 
dying  of  cholera,  and,  as  usual,  surrounded  by  neigh- 
bors, praying  and  repeating  the  litany.  Both  these 
men  had  spent  the  day  previous  at  work  on  the  beach, 
and  had  joined  with  the  curious  to  look  at  the  dying 
emigrant  lying  on  the  wharf.  During  this  Sunday 
many  other  cases  broke  out. 

157.  At  this  time,  1832,  there  scarcely  existed 
such  a  place  as  a  "  tenement  house"  in  Montreal. 


I 


M 


ITINGRART  IN  CANADA. 


123 


Each  French  Canadian  had  his  own  house,  small, 
neat,  clean  and  comfortable,  with  at  least  a  yard,  and 
often  a  small  garden.    They  were  all  acquainted 
with  each  other,  and  mostly  intermarried.     From  this 
close  relationship  a  death  could  scarcely  occur  that 
the  moribund  was  not  surrounded  by  relatives  and 
neighbors,  praying.     A  happy    people,   living   on 
little,  but  a  suflBciency,  and  contented.    This  kind 
habit  of  attending  to  the  dying  exposed  those  who 
assisted  to  the  contagion,  and  they  carried  it  into 
their  own  families.    Hence,  if  nothing  else  conspired, 
abundant  means  for  the  spread  of   the  pest  was 
established.      It  is,  therefore,  not  surprising  that  by 
Tuesday  morning,  the  12th,  there  were  accumulated 
in  the  Roman  Catholic  burying  ground,  St.  Antoine 
suburbs,  over  100  unburied;  fame  said  200.    This 
excited  great  clamor — some  one  must  be  blamed — 
this  fell  on  the  Health   Commissioner.      I  imme- 
diately prepared  to  burn  all  above  ground;  this  made 
a  still  greater  clamor;  1  was  remonstrated  with  by 
busybodies  on  behalf  of  the  suburbs,  people  who 
feared  that  the  smoke  would  spread  the  pestilence. 
My  reply  was :  dig  graves,  if  you  want  the  bodies 
buried — that  is  not  my  office;  if  graves  are  not  fur- 
nished I  shall  burn.    The  gentlemen  of  the  seminary 
addressed  the  people  at  the  church  door,  and  these 
turned  out  and  dug  trenches,  10  feet  wide,  8  deep, 


n 


n 


n 


124 


ASIATIC   CHOLERA. 


over  100  long.  The  dead  were  closely  packed  there 
in  tiers  three  to  four  deep,  and  covered  over  with 
earth,  leaving  the  remainder  of  a  trench  to  receive 
new  comers.  Several  such  trenches  were  filled  from 
first  to  last,  and  many  respectable  persons,  incapable 
of  getting  a  private  grave,  were  herein  buried.  It 
was  diflferent  in  the  Protestant  grave-yards — the 
number  of  deaths  being  much  less  than  among  the 
Catholics,  as  the  latter  made  up  the  majority  of  the 
population. 

158.  I  must  now  return  to  the  Voyageur,  a  pesti- 
lent steamer,  owned  by  speculators,  whose  morality 
lay  in  profit.  As  this  vessel  carried  her  live  cargo 
from  Quebec  to  Montreal  without  stopping  on  the 
way,  no  one  between  the  two  cities  was  infected.  It 
was  said  that  she  threw  overboard  several  dead  on 
the  passage,  but  I  was  unable  to  establish  the  truth 
of  the  accusation.  However,  I  discovered  the  follow- 
ing fact :  after  passing  Sorel  about  a  mile  a  feather 
bed  was  thrown  overboard,  and  floated  down  the 
river;  a  man  named  Latour,  a  small  farmer,  and 
occasionally  a  small  meat  butcher,  saw  the  object. 
He  paddled  out  in  his  canoe,  picked  up  the  bed,  took 
it  to  his  house  at  the  point  of  the  Island  St.  Ignace, 
and  began  to  dry  it.  This  man  took  cholera  and 
died  in  12  hours;  his  wife  also  took  the  pest  and 
died.     An  old  man  and  his  wife  lived  on  their  little 


ITINERARY  IN  CANADA. 


125 


property  a  mile  above  the  village  of  Contrecoeur, 
where  the  river  is  several  miles  wide.  He  was  out 
in  his  canoe  fishing,  when  a  raft  came  slowly  floating 
along  with  the  current.  The  captain  of  the  raft 
spoke  the  old  man  and  requested  him  to  take  one  of 
his  men,  dead,  ashore,  and  bury  him  on  the  beach. 
The  old  man  had  not  heard  of  cholera,  and  took  the 
body  ashore  and  buried  it;  this  was  on  Saturday 
afternoon.  During  the  night  the  old  man  took  ill 
and  died;  his  wife  also  sickened,  and  on  Sunday 
morning  the  passing  neighbors,  seeing  the  house 
shut,  mentioned  the  fact  to  his  nephew  at  the  parish 
church.  The  nephew  went  to  his  uncle's  house, 
found  the  old  man  dead,  and  the  woman  about  to 
expire.  After  doing  his  duty  to  them  he  returned  to 
his  home,  a  farm  in  the  "  Second  Range."  He  took 
ill  and  died,  but  the  intermediate  people  escaped. 
A  drover,  I'rench  Canadian,  left  Sorel,  then  slightly 
infected  (and  never  much),  to  go  to  the  Eastern 
townships;  on  his  way  he  had  to  pass  through  a 
dense,  primitive  and  uninhabited  forest,  seven  miles 
across,  in  the  centre  of  which  there  was  one  of  the 
little  wayside  taverns,  the  only  house;  here  he  halted 
about  midnight,  took  some  refreshment,  and  in  an 
hour  or  two  set  out  to  complete  his  journey.  The 
next  day  the  innkeeper  was  attacked,  and  after  him 
his  wife;  both  died,    If  these  are  not  cases  of  cpu- 


I  t 


!l 


1    t 


126 


ABUTIO  CHOLERA. 


tagion,  what  else  can  they  be  ?  I  will  add  one  more 
case,  taken  from  an  American  paper :  "  Oneida 
Castle,  July  23d :  The  captain  of  a  passing  boat 
hired  an  Indian  to  bury  a  man  from  on  board. 
The  Indian  was  immediately  after  seized,  and  died; 
five  other  Indians  were  also  attacked;  all  of  them 
died." 

159.  All  the  above  are  cases  of  attack  produced 
by  immediate  intercourse  with  infected  persons,  at  a 
time  when  such  a  pestilence  as  Asiatic  cholera  was 
unknown,  and  had  never  before  existed  in  the 
country.  All  sudden  attacks,  breaking  out  within 
12  hours  after  exposure,  and  all  of  them  astounding 
and  ending  in  death;  all  among  people  who  lived, 
each  in  his  own  house,  comfortably  and  healthy. 

^  60.  A  city  newspaper,  of  June  16th,  says:  "  Busi- 
ness seems  paralyzed.  Physicians  and  ministers  in 
vehicles  ply  with  velocity  day  and  night  through  all 
parts  of  the  city  and  suburbs;  druggists  and  apothe- 
caries keep  their  shops  open  all  night.  On  Friday 
morning  the  carts  again  appeared  in  the  streets, 
bearing  two  or  more  coffins  each,  some  with  lids 
unfastened,  and  some  corpses  without  coffins,"  This 
was  true.  As  regards  coffins,  I  set  carpenters  to 
work  to  make  them  out  of  rude  boards.  I  had 
several  depots  of  these  coarse  boxes,  and  furnished 
them  on  application,  by  a  ticket,  to  all  those  who 


ITINEBABY  IK  CANADA. 


127 


called  for  one;  among  the  number  were  many  re- 
spectable persons  who  could  pay  f  decent  coffins, 
but  none  could  be  had  other  than  those  I  furnished; 
they,  therefore,  called  at  the  office  for  them.  I 
remember  one  poor  Irish  woman  who  had  lost  her 
husband  and  could  not  call  or  send  for  a  coffin;  she  put 
her  husband,  doubled  up,  into  a  chest,  hailed  a  passing 
cart,  and  in  this  way  sent  the  corpse  to  the  public 
trenches.  It  was  no  unusual  thing  for  a  carter  of  the 
dead  to  call  out,  on  passing  a  house,  have  you  any 
one  to  send  to  the  burial  ground?  In  this  way  he 
would  get  from  two  to  four  at  a  load,  and  call  on  me 
for  his  pay. 

These  remarks  may  appear  irrelevant;  but  I  give 
them  to  show  how  dreadful  the  mortality  was  for  the 
first  two  weeks.  There  were  a  few  wealthy  persons 
who  procured  a  better  style  of  coffin  for  themselves. 

161.  Leaving  the  appalling  throng  of  cases  occur- 
ring among  the  lower  and  a  higher  class  of  sufferers, 
I  shall  now  notice  what  occurred  among  the  upper 
class,  who  were  all  well  off.  On  the  15th,  only  five 
days  after  the  outbreak,  the  Seignior  Saveuse  de 
Beaigeu  was  attacked  and  died  in  about  twelve  hours. 
He  lived  in  his  own  house,  a  fine  one,  in  a  healthy 
street,  with  his  daughter  and  two  old  servants;  the 
rest  of  his  family  he  sent  to  his  seigniory,  where  they 
escaped.     Tuesday,  June    26th,  Miss  Uervieux,   a 


•I 


128 


ASIATIC   CHOLERA. 


young  lady,  callod  to  keep  her  friend,  Miss  de 
Beaujeu,  company.  She  was  taken  ill  in  the  even- 
ing, about  10  o'clock,  full  dressed;  but  feeling  much 
restraint  from  the  presence  of  two  or  three  young 
gentlemen,  night-watchers,  remained  dressed,  sitting 
in  an  arm-chair;  she  died  about  daylight,  the  27th. 
At  once  a  co£Qn  was  ordered,  a  passing  cart  called, 
and  immediately  sent  off  to  the  burial  ground,  her 
family  not  knowing  what  had  occurred.  I  mention 
this  case  since  it  created  much  extravagant  talk  then, 
and  which  took' some  years  to  sub^i'de;  also  because 
it  was  affirmed  that  she  was  buried  alive,  in  the  dress 
she  died  in,  and  her  jewelry  on  her.  To  confirm  the 
statement  of  her  being  alive,  it  was  stated  that  she 
moved,  or  twitched,  on  being  put  into  the  coffin.  This 
case,  if  true,  is  the  only  one  noticed  in  Montreal  of  a 
choleraic  corpse  moving  after  death,  as  was  men- 
tioned in  European  journals  to  have  occurred. 

162.  On  the  15th,  in  the  night,  died,  at  one  of  the 
cholera  dispensaries.  Grant  Struthers,  a  medical  stu- 
dent, and  next  day  Dr.  Smith,  and  Pierre  Delorme,  a 
rich  man.  Benjamin  Thatcher,  who  left  in  the  even- 
ing to  go  to  Vermont  to  escape  the  pest,  died  on 
the  road  in  the  morning.  On  Monday,  Campbell 
Sweeney,  Esq.,  and  Mrs.  Try;  the  latter  was  left  alone 
in  her  room  with  her  servants.  Her  house  was  situa- 
ted in  the  centre  of  a  large  orchard,  at  a  distance 


ITINERARY   IN  CA^N     '^A. 


129 


from  other  houses,  spacious,  airy  and  luxuriouH.  20;  h, 
Harry  McKenzie,  Esq.,  N.  W.  Company,  rich,  inb  »• 
itod  his  own  fine  house;  Stephen  Sewell,  Esq.,  Solici 
tor-General.  A  young  lawyer,  Levi  Adams,  recently 
married,  lived  in  a  new  house,  all  of  the  furniture  of 
which  was  new,  in  a  remarkably  healthy  locality,  St. 
F.  Xavier  street,  adjoining  the  seminary  garden — he 
died;  the  next  day  his  wife  and  the  servant  girl  died 
— a  whole  family  blotted  out  in  two  days.  Horace 
Dickenson,  wealthy,  in  an  airy  house,  only  a  few 
hours  ill.  June  21st,  Jean  Bouthillier,  Esq.,  ^en., 
and  his  daughter,  Mrs.  Panet;  Pierre  Beaudry,  Esq., 
and  his  son,  living  in  a  large  orchard,  dry,  healthy, 
and  very  wealthy,  both  died;  my  much  esteemed  and 
wealthy  friend,  Benjamin  Beaubien,  Esq.,  attorney; 
John  Flemming,  Esq.,  President  of  the  Montreal 
Bank;  Miss  Moffatt,  aged  15,  daughter  of  Geo.  Mof- 
fatt,  Esq.,  the  largest  importing  merchant  in  the  city; 
Mary  Coton,  of  Tamworth,  England.  On  the  7th 
August,  Thomas  Gibb,  merchant,  and  many  others. 
26th,  Rev.  Newglove,  at  the  residence  of  Wm.  Lunn, 
Esq.;  residence  wealthy,  beautiful  and  salubrious. 
These  few,  out  of  a  great  number  of  cases  I  might 
cite,  will  suffice  to  show  that  cholera  spared  not  the 
affluent  more  than  the  lower  orders;  and  as  regards 
intemperance,  there  could  be  no  greater  libel  uttered 
th!:^n  even  to  hint  at  such  a  vice  existing  among  peo- 


..  ! 


130 


ASIATIC  CHOLERA. 


!:l 


!  f 


pie  of  their  rank  and  respectability.  If  a  statistic 
of  all  the  cases  were  taken,  it  would  show  that  the 
proportion  of  deaths  among  the  wealthy  and  well 
conducted  people  was  proportionately  greater  than 
among  the  lower  orders;  and  as  to  cleanliness,  the 
habitations  of  the  suburbs  people,  of  course  not  opu- 
lent, were  cleanly,  Comfortable,  and  well  supplied 
with  wholesome  living,  in  a  decree  and  quantity  suf- 
ficient for  the  wants  of  a  modest  and  contented 
people. 

163.  By  the  12th  we  managed  to  get  into  some  sys- 
tem and  organization.  Temporary  hospitals  (sheds) 
were  built;  a  steward,  cooks,  nurses,  etc.,  located  there- 
in, under  the  excellent  medical  attendance  of  the  Resi- 
dent Physician,  Dr.  de  Beaubien,  and  several  advanced 
students  who  resided  in  an  adjoining  building.  These 
sheds  were  got  up  in  a  hurry,  and  were,  of  course, 
very  imperfect  in  structure  and  furniture  for  the  first 
few  days,  because  it  was  no  easy  matter  to  get  work- 
men to  expose  themselves  in  such  a  pestiferous  place. 
For  want  of  cots  and  beds,  straw  was  thickly  laid  on 
the  floor  as  a  hurried  means  of  some  comfort.  As 
usual  in  such  times,  an  ignorant  newspaper  editor  (a 
pest  to  society)  and  a  pair  of  intermeddling,  discon- 
tented parsons  made  one  visit  to  the  place — a  short 
oncj  for  they  were  fearful  of  their  own  persons — and 
early  the  next  morning  their  paper  came  out  with 


ITINERARY  IN   CANADA. 


Idl 


venomous  diatribes :  *'  the  Bhods  ought  to  bo  called 
slaughter  houses;  we  found  the  jiaticntH  lying  on 
straw  on  the  floor,  no  bedsteads,  no  bods;  we  turned 
away  in  disgust  1"  How  easy  it  is  to  censure,  when 
one  is  under  the  protection  of  the  **  liberty  of  the 
press/'  and  comfortably  seated  out  of  rosponsibility- 
and  danger!  Had  the  libelers  made  a  true  state- 
ment, they  should  have  stated  that  the  condition  of 
the  shed  was  the  best  that  the  anxious  authorities 
could  procure  in  so  short  a  time — a  time  of  panic. 
As  soon  as  workmen  could  be  had,  trestle  bedsteads 
were  supplied,  palliasses,  sheets  and  pillows;  but 
these  guardians  of  the  public  never  returned  to  see 
the  "  slaughter  houses,"  and  to  withdraw  their  libel. 
Wine,  brandy,  cordials,  condiments,  the  best  of  fresh 
meat  and  poultry,  were  supplied  without  stint,  also 
unremitting  care.  The  Resident  Physician  was  at 
his  post  at  five  o'clock  in  the  morning;  the  students 
remained  night  and  day,  assiduously  administering  to 
the  wants  and  comforts  of  the  patients.  Did  the  edi- 
tors and  psalmodists  "  do  likewise  ?"  Only  once,  and 
that  was  to  make  a  "  sensation  paragraph."  The  only 
clergymen  unfearful  and  unremitting  in  attendance 
were  the  Sulpieian  Roman  Catholic  clergy;  occa- 
sionally, but  very  rarely,  a  Protestant  Episcopal,  and 
one  Presbyterian  clergyman,  paid  a  hurried  visit  to 
the  "  slaughter,  house.'^    Dr.  de  Beaubien  at  once  es- 


132 


ASIATIC   CHOLERA. 


I  I 


tablished  a  burial  ground  at  a  distance  on  the  com- 
mon, kept  graves  ready  open  to  receive  the  dead,  and 
buried  them  as  soon  after  death  as  possible.  He 
used  chloride  of  lime  freely  there,  in  and  about  the 
hospital.  Almost  every  one  that  died  he  carefully 
examined,  or  had  the  autopsies  conducted  by  his  as- 
sistant students,  as  soon  as  no  doubt  remained  of 
death,  and  carefully  observed  what  the  scalpel  could 
reveal.  I  feel  it  to-be  my  duty  to  bear  the  above  tes- 
timony to  the  meritorious  conduct  of  the  parties 
concerned,  although  I  have  had  no  intercourse  with 
them  since  thirty  years. 

164.  The  next  sanitary  step  to  meet  the  anxious 
wants  of  the  public,  but  of  little  real  use,  was  to 
establish  a  number  of  dispensaries,  under  the  care  of 
trusty  students  who  had  instructions  for  their  guid- 
ance. These  places  were  supplied  with  necessary 
drugs,  and  given  to  all  who  applied,  night  and  day, 
gratuitously.  Whatever  good  they  may  have  done, 
one  thing  is  certain,  it  contented  the  people. 

166.  At  the  outbreak  of  cholera  Montreal  had  a 
population  of  32,000  souls  and  thirty  licensed  physi- 
cians and  surgeons,  two  small  schools  of  medicine 
and  a  number  of  students.  On  the  regular  practi- 
tioners devolved  all  the  duties  of  medical  attendance, 
about  one  practitioner  to  a  thousand  well  and  ill  per- 
sons, if  equally  divided,  which  was  not  the  case. 


ITINERARY  IN    CANADA. 


133 


There  were  three  hospitals — the  long  established 
Hotel  Dieu,  the  Gray  Nuns'  Infirmary,  and  a  new 
and  excellent  establishment,  the  Montreal  General 
Hospital,  well  conducted.  Such  were  the  only  medi- 
cal means  to  meet  an  appalling  pestilence,  hitherto 
unknown  to  Canadian  practitioners,  and  wlio,  like 
all  over  elsewhere,  supposed  the  plague  to  be  a  dis- 
ease, and  consequently  brought  to  their  aid  the  dog- 
mas of  the  schools — physiological  axioms  that  had  no 
bearing  on  the  complaint,  and  which  cholera  refuted. 
The  metJiodus  rrwdendi  founded  on  such  principles 
had  no  application  here,  proved  useless  in  every 
case,  and  injurious  in  many.  But  scholastic  educa- 
tion enables  the  weak  minded  to  argue  with  an  ap- 
parent display  of  real  knowledge,  and  to  override 
and  subdue  common  sense. 

166.  The  town  of  Three  Rivers,  half  way  between 
Quebec  and  Montreal,  forbid  steamers  to  come  into 
their  port,  by  which  restriction  the  inhabitants 
escaped  for  a  while,  until  some  retrograde  traveler 
from  Sorel,  above,  brought  the  pest  among  them; 
but  it  did  not  spread  much.  Sorcl,  a  steamer  port, 
was  early  affected,  but  had  few  cases.  This  is  easily 
explained,  as  that  borough  contains  a  divided  popu- 
lation that  keeps  each  aloof  from  the  other,  and  is 
very  unsociable.  On  both  banks  of 'the  St.  Lawrence, 
with  a  dense  population,  scarcely  a  case  occurred 
7 


ASIATIC   CHOLERA. 


before  six  weeks,  because  no  direct  communication 
with  Quebec  existed — and  no  travel  in  the  agricul- 
tural season  takes  place,  excepting  that  of  going  once 
a  week  to  the  parish  church. 

167,  From  Montreal  it  was  different:  the  great 
influx  of  emigrants  was  fr  warded  away  by  the  Emi- 
grant Society  as  fast  as  they  arrived,  and  by  them 
the  pestilence  was  sown  at  each  stopping  place. 
Lachine  first,  then  The  Cedars,  next  Coteau-du-Lac, 
Cornwall,  Prescott,  Kingston,  Toronto,  Niagara,  etc., 
to  Sandwich,  in  Upper  Canada,  and  to  the  opposite 
towns  in  the  State  of  New  York,  spreading  from 
town  to  town  until  it  reached  New  Orleans.  From 
Montreal  to  St.  John's,  thence  through  Lake  Cham- 
plain,  infecting  the  New  York  towns  of  Champlain, 
Chazy,  Plattsburgh  and  White  Hall,  to  Albany;  on 
the  Vermont  side  attacking  Burlington,  and  extend- 
ing to  the  interior  towns  of  the  State;  but  in  all  these 
places  the  great  fury  of  the  invasion  seemed  to  have 
already  expended  its  greatest  force  in  Lower  Canada. 
Although  I  have  the  dates  of  the  successive  marches 
of  the  pestilence  from  Montreal  through  Upper 
Canada,  and  into  the  United  States  to  the  Atlantic 
sea-board,  and  down  to  New  Orleans,  I  abstain 
giving  the  calendar,  that  I  may  not  overload  this 
small  book. 

168.  IJoweverj  I  must  notice  the  march  of  cholera 


ITINERARY  IN  CANADA. 


135 


up  the  Ottawa,  because  the  itinerary  is  exact  and 
particular.  In  1832  the  banks  of  this  river  were  still 
lined  with  the  primeval  forests,  and  small  settlements 
existed  only  here  and  there  at  special  landing  places, 
as  the  current  is  frequently  interrupted  by  rapids, 
cascades,  and  unavoidable  "  portages." 

169.  Travelers  up  the  Ottawa  carried  cholera  to 
Carillon,  Greenville,  Point  Fortune,  Fox  Point,  on 
one  side  of  the  river,  on  the  other  to  Rigaud,  New 
Longueil,  Plantagenet,  etc.,  to  Bytown,  the  terminus 
of  travel,  which  place  it  reached  5th  July,  brought 
there  by  a  woman  passenger  ^on  steamer  Shannon; 
she  died  the  day  after  landing.  Next  day  died  the 
landlord  of  the  house  she  was  taken  to,  also  the 
people  in  attendance  on  her  and  him;  88  died.  At 
Rigaud  there  died  80,  from  the  8th  July  to  9th 
August.  On  the  10th  Dr.  Teasdale  died.  New  Edin- 
burgh, near  Bytown,  was  dreadfully  ravaged.  At 
Plantagenet,  Ottawa,  died  Mr.  M'Kay,  a  young  man 
in  the  service  of  Mr.  Chester,  14  miles  away.  His 
mother  went  to  his  relief.  On  her  return  she  took 
ill,  and  died  in  a  few  hours.  Mr.  Chester,  Sen.,  took 
ill  at  once  and  died;  Mrs.  Chester  died.  Many  neigh- 
bo:  s  attended  her  funeral,  took  ill,  and  all  of  them 
died;  Miss  Chester  died  ;  her  brother,  Guy  Chester, 
died,  and  a  sister,  Mrs.  Molloy,  died. 

170.    When  it  is  considered  that  this  was  a  new, 


f 


! 


j  I 


186 


ASIATIC   CHOLERA. 


a  forest  country,  and  remarkably  healthy,  and  that 
the  pest  was  brought  there  and  immediately  scourged 
the  people  who  communicated  with  each  other,  and 
to  none  other,  we  leave  to  the  theorist  to  find  and 
explain  any  other  cause  than  contagion  for  what  is 
now  mentioned. 

171.  Opposite  Lachine  is  the  Iroquois  village  of 
Caughnawaga.  Here  88  Indians  died.  These  people 
were  much  exposed  to  the  pest  being  brought  among 
them  from  the  occupation  of  the  men,  which  was  that 
of  piloting  rafts  through  the  rapids.  At  the  Lake  of 
Two  Mountains  is  a  village  of  Iroquois,  and  an  ad- 
joining village  of  Algonquins;  but  here  only  two  died. 
The  explanation  is  easy.  As  soon  as  summer  is  set  in 
the  most  of  the  people  depart  to  the  hunting  grounds, 
and  the  few,  with  women,  that  remain,  do  not  travel 
about ;  nor  is  their  place  a  thoroughfare  of  travel,  as 
is  Chateauguay,  where,  from  the  14th  June  to  16th 
of  August,  146  died. 

172.  A  case  of  second  attack  took  place  in  Mon- 
treal August  13th,  and  ought  not  to  be  passed  over  in 
silence.  Mr.  Alexander  Gray,  of  the  firm  of  Gray  & 
Co.,  auctioneers,  aged  31,  took  ill  on  Sunday  and 
died  early  on  Monday,  the  13th.  He  had  quite 
recovered  from  a  former  attack,  and  attended  to  busi- 
ness more  than  a  week,  when  he  was  suddenly  killed 
by  this  second  attack.    There  were  other  instances  of 


'H--'  1 


ITINERARY  IN   CANADA. 


137 


a  second  attack,  but  it  is  sufficient  to  notice  one  by 
name  and  date. 

173.  August  9th.     Rev.  Dayid  Hughes,  Unitarian 
minister  of  Yeoville,  Somersetshire,  England,  aged 
47  :  on  Thursday  he  left  his  family,  in  perfect  health, 
in  company  with  his  eldest  daughter,  to  go  to  Upper 
Canada.    While  on  the  boat,  from  Lachine  to  the 
Cascades,  he  was  ill;  there  were  no  berths,  and  he 
had  to  recline  as  best  he  could.    At  The  Cedars  they 
took  the  stage  to  Coteau-du-Lac;  by  this  time  he,  suf- 
fered much  from  vomiting  and  purging,  but  could  not 
prevail  on  the  driver  to  stop  more  than  once  or  twice. 
When  he  got  to  the  Coteau  a  doctor  said  he  must  not 
proceed.    He  continued  cramped  for  some  hours,  was 
deeply  blue,  and  died  at  8  p.m.;  was  conscious  to  the 
last,  and  was  hurriedly  buried  in  the  night.    Now 
comes  the  important  part  of  the  case.    His  distressed 
daughter  returned  to  Montreal,  and  either  took  back 
or  sent  back  his  luggage.    Among  this  was  a  carpet- 
bag containing  some  of  the  foul  clothes  he  had  worn. 
This  carpet-bag  was  taken  into  the  garret  of  the  house 
where  he  had  resided  in  Montreal,  Mr.  Ariel  Bow- 
man's, bookseller,  St.  F.  Xavier  street,  and  hung  up. 
The  Sunday  following,  his  youngest  daughter,  who 
remained  behind  at  Mr.  Bowman's,  went  to  play  with 
two  of  Mr.  Bowman's  children.     They  took  down  the 
bag,  overhauled  the  contents;  in  a  vest  pocket  Miss 


1 


138 


ASIATIC   CHOLERA. 


Hughes  found  a  copper  cent,  took  it  as  a  remembrance 
of  her  father.  This  was  Sunday  afternoon — the  whole 
household  perfectly  healthy  at  the  time.  At  4  a.m.. 
20th  Aug.,  Monday,  I  was  sent  for  to  see  two  of  Mr. 
Bowman's  children;  they  were  both  choleraic — very 
bad;  these  were  his  two  children  who  had  overhauled 
the  carpet-bag.  After  prescribing  for  these  two,  a 
message  came  for  me  to  go  to  another  part  of  the 
house;  there  I  found  Mr.  Hughes'  second  daughter, 
Sarah  Hughes,  11  or  12  years  of  age,  very  ill  of 
cholera,  of  which  she  died  in  two  or  three  hours  more. 
This  girl  went  to  bed  perfectly  well,  and  could  not 
have  been  ill  over  seven  hours.  Mr.  Bowman's  two 
daughters  recovered.  These  three  cases  are  interest- 
ing, as  aflfording  an  instance  of  cholera  derived  from 
"  infected  goods."  Sept.  18th,  Mrs.  Bowman,  wife  of 
Ariel  Bowman,  took  cholera  and  died.  Heretofore 
no  cholera  existed  in  this  salubrious  street,  excepting 
the  cases  of  Levi  Adams,  his  wife  and  maid,  on  the 
20th  June. 

174.  The  garrison  of  Montreal  consisted  of  a  part 
of  the  15th  and  a  few  of  the  27  th  regiments,  some  of 
the  men  doing  outpost  duty  not  far  off — 450  men  in 
all;  of  these,  46  died.  On  the  19th  June  the  colonel 
encamped  his  men,  under  canvas,  on  the  Island  St. 
Helen,  maintained  strict  exclusion  and  seclusion  and 


ITINERARY  IN   CANADA. 


139 


perfect  hygiene;   the  result  was  that  no  more  deaths 
occurred  among  them. 

I  must  notice  a  few  exceptional  cases.  It  will  bo 
seen  that  a  large  number  of  the  attacks  were,  without 
the  least  premonition,  of  an  astounding  character — 
killed  in  a  few  hours ;  but  a  good  many  of  these 
attacks  seemed  to  have  at  once  purged  the  system  of 
the  poison,  and  such  patients  recovered  in  twelve  to 
eighteen  hours.  This  was  the  case  with  Mr.  Gray, 
the  auctioneer.     (See  Sec.  172.) 

175.  On  the  night  of  15th  June,  a  man  whom  I 
knew  by  sight,  but  not  by  name  nor  residence,  came 
into  the  ofl&ce,  about  12  o'clock;  when  it  came  to  his 
turn  I  asked  what  he  wanted;  he  said  he  came  for  a 
coffin  for  his  wife.  I  gave  him  an  order  for  one,  with 
which  he  went  off.  Before  1  a.m.,  the  same  night, 
a  close  and  very  hot  one,  among  others  a  man  came 
on  the  same  kind  of  errand,  and  said,  casually,  that  he 
passed  a  man  lying  on  the  pavement  opposite  the 
English  Episcopal  Church,  not  over  2,000  yards  from 
my  office.  At  once  I  sent  to  his  relief.  It  turned  out 
that  the  man  was  dead,  cold,  and  very  blue,  but  there 
was  no  appearance  of  his  having  vomited;  in  his  vest 
pocket  was  found  the  order  given  to  him  for  a  coffin 
for  his  wife,  less  than  an  hour  before.  The  body  was 
sent  to  the  dead-house,  Place  d'Armes,  and  thence  in 
the  morning  to  the  trenches.    I  did  not  know  his 


140 


ASIATIC    CHOLERA. 


name,  and  believe  that  his  friends,  if  he  had  any, 
remained  ignorant  of  his  sudden  death.  This  case  is 
cited  to  show  how  sudden  some  of  the  deaths  were. 

176.  A  horse.  John  Armstrong,  master  tanner, 
lived  in  a  two-story  house  on  St.  Antoine  Bridge. 
One  of  his  men  took  ill  of  cholera,  and  for  con- 
venience' sake  lay  on  a  buflfalo-robe  on  the  floor; 
he  soon  died.  The  robe  was  taken  to  the  stable  and 
thrown  into  a  manger  next  to  the  horse,  a  very  fine 
one.  Next  day  I  was  called  to  see  Armstrong,  ill  of 
cholera;  some  one  came  in  and  said  the  horse  was 
choleraic.  I  went  into  the  stable,  found  the  horse 
standing  up,  drooping,  his  ears  hanging,  his  skin 
damp  and  sticky  to  the  hand,  mouth  and  tongue  cold, 
breath  cold,  eyes  dull  and  undistended;  incessant 
purging  of  choleraic  matter,  the  ingesta  of  food  hav- 
ing previously  passed  away;  there  was  no  vomiting, 
because  the  structure  of  the  cardia  in  the  horse  does 
not  admit  of  vomiting.    The  horse  soon  died. 

177.  Poultry  died  in  some  places  in  the  St.  Antoine 
and  Quebec  suburbs  of  the  city,  with  all  the  appear- 
ance of  cholera.  Dogs  were  also  reported  to  me 
as  having  died  of  cholera.  But  on  neither  of  these 
instances  do  I  set  much  value,  for  fowls  are  subject 
to  a  disease  resembling  cholera,  and  dogs,  in  hot 
summers,  are  very  subject  to  vomiting,  and  diarrhoea, 
and  convulsions.      However,  in  India  the  reports 


I!  ! 


ITINERARY   IN   CANADA. 


141 


state  that  these  animals  died  off  in  great  numbers; 
and  at  Marienburg,  Prussia,  it  is  asserted  that  fish  in 
preserve  ponds  died  of  cholera  (!) — from  the  single 
pond  of  iJimperberg  40  tons  were  buried.  But  it  is 
well  known  that  many  poisons  mixing  in  the  water 
will  in  an  hour  kill  the  fish  it  comes  in  contact  with. 
Potash  is  one  of  these  deleterious  substances,  and 
only  a  little  will  empoison  a  large  extent  of  water, 
and  kill  every  fish  it  comes  in  contact  with.  This 
was  remarkable  after  the  great  fire  at  Mirimachi, 
that  destroyed  miles  of  forest,  about  forty  years  ago; 
the  rains  carried  the  alkali  into  the  bay,  completely 
destroyed  all  the  salmon  of  that  year,  and  greatly 
added  to  the  distress  of  the  people.  Swine,  it  is 
said,  took  cholera  in  Ireland  and  died. 

178.  No  correct  register  of  the  numbers  of  inter- 
ments at  the  Roman  Catholic  burial  ground  was 
made — indeed,  none  could  be  made;  for  during  nearly 
two  weeks  the  carters  carried  the  dead  to  the 
trenches,  not  knowing  or  caring  to  know  the  name 
or  even  the  sex  of  the  body.  They  picked  up,  as  it 
were,  the  bodies  as  they  went  along  the  streets,  or 
were  sent  for  to  cart  away;  they  were  common 
laborers,  who  could  not  even  read,  and,  of  course, 
were  incapable  of  making  a  list,  beyond  noting  the 
number  they  carted,  to  draw  pay  for  so  doing.    At 

the  Protestant  burial  ground  affairs  were  not  so  bad, 

7* 


142 


ABIATIO   CHOLERA. 


as  the  numbers  taken  to  them  were  much  less,  and 
most  of  them  of  a  better  class,  who  had  friends  to 
attend  to  the  burials. 

179.  It  is,  perhaps,  well  to  say  a  few  words  about 
the  Board  of  Health,  consisting  of  ten  to  fifteen 
magistrates  and  gentlemen — a  body  quite  outside  uf 
the  Medical  Commission,  and  having  only  advisory 
powers,  but  no  right  to  interfere;  nor  did  they  once 
intermeddle  or  give  us  any  trouble.  They  appointed 
a  secretary,  at  a  small  salary.  This  gentleman,  J. 
Guthrie  Scott,  Esq.,  attorney,  was  a  very  timid  man, 
and  never  once  left  his  house  to  attend  the  meetings 
of  the  board.  His  office  appeared  to  be  that  of  col- 
lecting daily  reports  of  cases  and  deaths;  but  he 
never  once  sought  for  the  reports  himself.  He 
managed  to  get  occasionally  a  partial  statement  by 
sending  a  note  for  it,  and  send  this  imperfect  docu- 
ment to  the  newspapers.  I  find  it  necessary  to  note 
this,  lest  any  one  who  may  look  over  the  files  of 
papers  for  this  period  should  be  led  into  the  very 
contradictory  errors  recorded.  Mr.  Scott  was,  as 
above  said,  a  very  timid  person.  He  had  recourse 
too  largely  to  brandy  to  keep  out  the  pestilence;  it 
overcome  him  and  his  judgment,  and,  becoming  a 
habit,  soon  terminated  his  existence.  With  this 
exception  he  was  an  unblemished  gentleman. 


:  I 


i, ! 


ITINERARY   IN   CANADA. 


143 


As  examples  of  the  reliance  to  be  placed  on  Mr. 

Scott's  "  Reports,"  take  the  following: 

"  June  13— Cases,     94.     Deaths,   23. 

June    15— Cases,  1,204.    Deaths,  230. 

Up  to  16— Cases,    —       Deaths,  102. 

"  J.  G.  Scott,  Sec." 

The  editor  of  Canadian  Courant,  Sept.  5th,  says: 
total  cases,  4,385;  deaths,  1,853.  The  editor  goes  on 
to  say,  on  his  own  account,  at  least  2,000  have  died; 
and  again  he  says,  from  June  10th  to  September  18th, 
deaths,  3,151.  Where  Mr.  Scott  got  his  numbers  I 
cannot  imagine;  but  I  notice  in  the  newspapers  that 
he  attached  my  name  to  some  of  his  reports.  It  is 
certain  he  never  once  called  to  see  me  nor  sent  to 
me  for  a  report.  Nor  can  I  say  more  in  favor  of  the 
Canadian  Courant,  Both  these  sources,  and  all  the 
published  accounts,  are  equally  erroneous.  Canadian 
Courant,  20th,  says,  many  shops  in  St.  Paul  street  are 
shut  up.  A  great  many  persons  have  fled  the  city  to 
escape,  and  were  seized  with  cholera  on  their  road  to 
an  imagined  place  of  safety. 

180.  The  Hotel  Dieu  ^Hospital,  a  cloister,  had 
only  one  case;  the  Congregation  Nunnery  had  none; 
the  Gray  Nunnery  Infirmary  had  only  two;  and  the 
jail  only  one  (perhaps  two).  A  number  of  doctors 
and  apothecaries  died,  and  several  priests  in  the 
parishes.    One  paper  estimated  that  the  total  number 


ii 


144 


ASIATIC   CHOLERA. 


ii' 


of  deaths  in  Lower  Canada,  witli  a  population  of 
600,000,  exceeded  that  of  Great  Britain,  with  a  popu- 
lation of  15,000,000. 

181.  For  the  first  fifteen  days  cholera  was  princi- 
pally confined  to  the  two  cities  of  Montreal  and 
Quebec,  while  both  shores  of  the  St.  Lawrence  be- 
tween these  places  nearly  escaped.  But,  at  last,  the 
pest  spread  from  Quebec  to  Point  Levi,  opposite,  and 
■was  gradually  extended  from  parish  to  parish;  many 
of  these  suffered,  statistically,  greater  mortality  than 
did  the  two  cities. 

182.  From  my  notes,  and  disbursements  to  carters 
and  for  coffins,  I  venture  to  say  that  the  deaths  in 
Montreal  reached  quite  to  4,000,  if  they  did  not 
exceed  that  number  a  little.  By  September  29th 
cholera  had  ceased  with  us. 

183.  A  few  words  only  will  suflSce  for  the  cholera 
of  1834.  It  did  not  appear  with  us  until  11th  July, 
and  ceased  by  the  end  of  August.  While  we  bad 
some  cases  of  astounding  cholera,  the  number  was 
less  than  in  1832,  and  taken  altogether  it  was  a 
much  less  disastrous  plague;  but  it  extended  like  in 
1832,  from  person  to  person  and  place  to  place,  in  no 
iijstance  until  a  contaminated  person  had  preceded 
the  outbreak. 

Of  Quebec,  with  a  population  of  28,000, 1  shall 
speak  only  as  I  derived  information  from  the  news- 


ITINERAUY   IN   CANADA. 


145 


papers,  one  of  which  was  always  considorcd  reliable, 
Neilson's  Gazette,  Juno  27th,  the  Oaxctte  states  the 
deaths  in  Quebec  to  that  date  at  1 ,200.  Juno  8th  to 
July  3d,  1,421  deaths;  to  July  18th,  1,0()2.  "No 
correct  estimate  of  public  health  can  bo  made  from 
the  reports.  In  the  hospital  there  have  been  943 
cases,  and  590  deaths.  But  this  hospital  received 
many  emigrants;  this  was  not  the  case  in  Montreal. 
The  number  of  deaths  are  moro  likely  to  exceed  than 
be  under  4,000.'' 

The  Quebec  papers  teemed  with  censures  of.  the 
cholera  authorities — with  what  justice  I  cannot  say, 
as  my  office  wai  confined  to  Montreal.  I  have  no 
doubt  they  often  expressed  no  more  than  tho  personal 
feeling  of  the  writers,  and  some  excuse  must  be  made 
for  excitement  during  a  public  calamity,  in  which 
newspaper  scribblers  notorioualy  take  great  liberties 
with  persons  who  are  otherwise  occupied,  and  who 
iitorn  to  reply  to  attacks  made  in  tho  safe  quarters  of 
a  newspaper  office. 


CHAPTER  VI. 


PATHOLOGY. 


184.  Let  us  begin  with  the  blood — not  that  it  is 
the  first  thing  disturbed,  but  because  we  must  begin 
somewhere;  not  that  any  change  in  its  appearance  is 
a  cause  of  cholera,  for  its  change  is  due  to  the  chol- 
eraic poison;  not  because  it  plays  any  role  of  import- 
ance, for  all  its  action  is  absolutely  negative — it  does 
nothing;  it  ceases  to  perform  even  its  allotted  office 
of  calorification.  Its  stagnation  on  the  surface  is 
what  first  attracts  our  attention;  and  if  we  look  into 
the  interior,  before  or  after  death,  we  find  the  same 
stagnation,  excepting  in  the  larger  vessels,  where  it 
only  fluctuates  to  and  fro,  but  does  not  circulate  in 
severe  cases. 

186.  Here  we  at  once  come  into  collision  with 
that  rough  and  superficial  physiology  taught  while 
studying  descriptive  anatomy.  1st.  It  is  daily 
taught  in  schools,  and  published  in  systems,  by  pro- 
fessors who  initiate  the  student  into  the  recondite 
but  as  yet  imperfect  science  of  medicine,  that  blood 


PATHOLOGY. 


147 


is  essential  to  animal  existence;  this  d'>ctrine  is  most 
untrue.  2d.  It  is  taught,  and  believed  by  superficial 
practitioners,  that  the  tissues  are  elaborated  out  of 
blood;  this  is  untrue.  3d.  Consequently,  that  there 
is  a  daily  consumption  of  much  blood;  this  is  untrue. 
4th.  It  is  taught  that,  to  supply  the  consumption, 
more  blood  must  be  made  daily;  this  is  untrue.  5th. 
It  is  taught  that  food  chymified  and  chylified  is 
the  pabulum  out  of  which  blood  is  made;  this  is  un- 
true. 6th.  Impressed  with  this  roundabout  way  of 
making  blood,  which  blood  so  made  daily  is  to  -cre- 
ate and  be  changed  into  tissue,  the  teacher  has  im- 
agined that  the  chyle,  in  its  progress  towards  mixing 
with  real  blood,  gradually  becomes  tinged  red, 
"  almost  evidently  "  so,  while  yet  in  the  thoracic  duct, 
when  it  has  reached  near  the  subclavian  vein;  this  is 
also  untrue.  My  belief  is,  in  this  instance,  like  a 
thousand  others,  the  teacher,  imbued  with  the  idea  of 
a  necessity  of  blood,  has  persuaded  himself  that  he  has 
seen  the  progressive  steps  of  that  creation.  As  early 
as  in  1815,  and  for  years  after,  I  undertook  many 
physiological  researches  on  digestion  and  on  this 
supposed  creation  and  use  of  blood;  but  I  was  dis- 
appointed. I  fed  many  cats,  dogs,  pigs,  etc.,  and  ex- 
amined the  chylopoetic  system  at  various  stages  of 
digestion;  but  my  disappointment  was  great  in  not 
meeting  with  what  I  had  been  taught  to  believe.    I 


148 


ASIATIC   CHOLERA. 


I 


rarely  met  with  even  a  tinge  of  red  in  the  thoracic 
duct.  This  was  one  of  my  first  sources  of  skepticism 
of  the  truth  of  doctrines.  It  is  omy  yesterday,  as  't 
were,  that  a  contributer  to  the  Philosophical  Trans- 
actions managed  to  get  accepted  a  paper,  and  a  draw- 
ing to  illustrate  it,  that  he  observed,  in  the  micro- 
scope, a  bloo  J  globule  unroll  itself  into  a  fibre  to  be- 
come muscular  tissue  I  I  believe  his  name  was  New- 
port, but  I  have  not  the  Transactions  to  refer  to. 

The  foregoing  digression  I  think  proper  to  make, 
so  that  I  may  not  be  misconceived  in  what  I  have  to 
say  about  blood  in  cholera. 

186.  Choleraic  blood,  in  the  cyanosed  state,  or  in  a 
protracted  case,  or  shortly  after  death,  is  found  to  be 
of  so  deep  a  purple  color  as  to  appear  nearly  black. 
It  is  viscid  from  the  absence  of  serum  and  much  of 
the  fibrin.    The  interpretation  is,  that  while  the 
diluting  serous  fluid  has  been  drawn  ofi^,  the  globules 
have  remained,  concentrated  in  number,  and  dark 
from  the  absence  of  aeration.    The  anatomical  charac- 
ter of  the  globule  is  not  altered;  it  preserves  the  disk 
form,  when  taken  out  of  the  sinuses  and  great  vessels; 
but,  if  the  blood  be  examined  in  the  capillaries,  it  will 
be  found  that  many  globules  are  diflfused  extra  vaso- 
rum;  and  that,  in  a  protracted  case,  many  will  be 
found  either  broken  down,  or  that  their  ha&matin  has 
escaped,  so  that  the  rete  mucosa  malpighi  becomes 


1  I 


PATHOLOGY. 


149 


permanently  stained,  which  is  the  cause  of  the  pro- 
tracted color  seen  in  cases  called  the  typhoid  stage. 

187.  The  heart  and  great  vessels  near  to  it  are  all 
filled  with  thick  Tiscid  black  blood,  which  blood  con- 
tains an  amount  of  globules  vastly  in  proportional 
excess  of  ordinary  blood.  The  right  ventricle  and 
auricle  are  always  full,  and  the  left  is  nearly  in  the 
same  state.  The  pulmonary  artery  and  vein  show  no 
diflference  in  the  quantity  of  the  blood  they  contain. 
All  the  arteries  contain  some  black  blood.  This 
should  be  anticipated  by  a  physiologist  well  ac- 
quainted with  the  movement  of  the  blood  in  these 
vessels  during  life,  also  after  death.  It  is  stated  by 
professors  that  the  arteries  are  empty  after  death; 
true — excepting  in  special  cases  reported  as  sud- 
den death,  and  death  from  lightning;  but  such  cases 
I  have  not  examined,  and  do  not  know  the  fact  from 
my  own  knowledge.  I  shall  now  stop  a  moment 
to  say  a  few  words  on  empty  arteries  after  death. 

188.  In  disease  the  course  of  the  blood  through 
the  vessels  does  not  cease  at  death,  at  the  arrest  of 
the  impulse  of  the  heart  on  the  arterial  column.  The 
veins  continue  to  deplete  the  arteries  of  their  blood 
for  several  hours  after  what  is  called  death  has  taken 
place.  This  depletion  is  due  to  a  suction  property 
in  the  extreme  veins,  a  power  so  great  that  all  the 
blood  in  the  arteries  is  drawn  out,  and  the  round  cal- 


III 


Pi 


Ui 


mmmm 


150 


ASIATIC    CHOLERA. 


iber  of  the  arteries  is  forced  into  a  flat  cord,  in  spite 
of  the  strong  resistance  of  the  arterial  coat,  ceases 
by  tending  to  resume  the  cylindrical  form,  but  can- 
not do  so  unless  something  enter  to  replace  the  vacu- 
um which  the  venous  suction  has  created.  If  a  large 
artery,  like  the  carotid  or  the  femoral,  be  carefully 
laid  bare,  it  will  be  found  empty,  and  of  course  flat; 
but,  Cb  soon  as  a  cut  is  made  into  it,  admitting  a 
rush  of  e*r,  the  vessel  will  at  once  expand  and  be- 
come an  empty  cylinder.  This  I  have  taught  many 
years  ago,  and  should  not  now  recur  to  it  were  it  not 
that  not  a  word  on  the  cause  of  empty  arteries  is  to 
be  found  in  dass-books, 

189.  In  cholera  the  veins  quickly  cease  to  act, 
draw  no  longer  on  the  arteries,  and  consequently  do 
not  influence  the  motion  of  what  blood  remains  in 
the  arteries,  which  is  necessarily  black,  since  the 
lungs  cease  to  aerate  the  blood  many  hours  before 
death;  the  heart  still  acting,  causes  only  a  flux  and 
reflux  of  the  blood  nearest  to  it,  but  effects  no  cir- 
culation. Under  these  extraordinary  circumstances, 
it  must  be  expected  that  blood  of  a  black  color  will 
be  found  in  the  arteries. 

190.  It  is  curious  to  see  both  arteries  and  veins 
equally  filled  with  black  blood,  coursing  languidly 
through  the  mesentery  during  life,  as  I  have  seen  in 


PA^HOLOGr. 


151 


the  Caesarean  sections  performed  with  tho  delusive 
hope  of  saving  the  life  of  a  foetus. 

191.  Cavity  of  the  skull  and  the  brain  are  the  next 
places  where  pathological  change  has  often  been  as- 
serted to  exist.  When  the  calvarium  is  removed, 
the  dura  mater  and  the  sinuses  cut  across,  a  large 
quantity  of  the  same  kind  of  blood  seen  in  the  heart 
will  run  out.  A  very  limited  knowledge  of  the 
brain-box  would  anticipate  such  a  state  to  exist  in 
cholera:  Jirst,  the  brain  substance,  like  all  other 
parts,  would  be  drained  as  well  as  all  the  arachnoid 
liquor,  and,  of  course,  diminished  in  volume;  second, 
as  this  osseous  cavity  is  closed  on  all  sides,  except- 
ing where  vessels  enter  and  leave,  should  the  brain 
diminish,  blood  would,  of  a  physical  necessity,  rush 
in  to  fill  the  vacuum.  Hence  it  is  that,  in  many  other 
cases  than  cholera,  the  sinuses  and  vessels  within  the 
skull  are  found  to  contain  more  blood  than  when  the 
brain  has  not  been  diminished  in  size.  The  pneuma- 
tism  of  a  closed  cavity,  with  unyielding  walls,  will, 
of  necessity,  suck  blood  from  the  nearest  sources  to 
fill  the  vacuum.  This  has  been  fully  demonstrated 
more  than  fifty  years  since.  Notwithstanding  this 
simple  physical  truth,  the  presence  of  this  insolite 
quantity  of  blood  is  everywhere  called — 

192.  Congestion,  "  The  brain  is  much  congested  in 
cholera"  is  repeatedly  stated,  as  if  congestion  of  a 


(i 

*  {  r 

it* 

HI' 


n 


152 


ASIATIC    CHOLERA. 


part  constituted  a  diseased  state  there.  The  hack- 
neyed word  congestion  is  much  in  use,  and  a  very 
convenient  one  to  explain  to  the  ignorant  something 
which  he  who  employs  it  does  not  exactly  know 
himself,  and  which  does  not  exist,  and  if  present  any- 
where does  not  constitrte  a  diseased  state.  If  con- 
gestion were  disease,  scarcely  any  young  woman 
would  be  free  from  disease  of  the  face,  since  she  often 
has  even  extreme  congestion  of  the  face,  a  conges- 
tion that  rapidly  comes  and  goes  and  leaves  no  trace 
behind.  Congestion  of  the  sexual  organs  is,  I  fancy, 
very  common  in  both  sexes,  and  is  sometimes  much 
prolonged  and  often  repeated,  but  does  not  disorder 
the  part  in  which  it  exists  or  produce  inflammation, 
which  is  a  disease.  There  is  scarcely  a  single  viscus 
concerned  in  nutrition  that  is  not  necessarily  con- 
gested daily,  but  leaves  no  trace  of  disorder.  This 
word  is  the  creation  of  a  pathologist's  imagination, 
who,  when  he  cannot  on  dissection  discover  the  seat 
of  a  disease  he  is  in  search  of,  but  finds  a  cadaveric 
appearar.ce  due  to  accumulation  of  blood,  after  death, 
does  not  hesitate  to  exclaim,  great  congestion!  Med- 
ical writings  teem  with  this  convenient  word. 

193.  Having  sufficiently  discussed  the  circulation, 
or  rather  the  presence  of  blood  in  the  vessels,  let  us 
now  contemplate  the  blood  itself. 

194.  Choleraic  hlood.    In  order   to  comprehend 


PATHOLOGY. 


153 


\ 


well  what  change  cholera  has  exerted  on  the  blood, 
it  will  be  well  to  say  a  word  about  healthy  blood, 
which  varies  greatly  in  the  quantity  of  serum  present 
at  different  periods,  even  in  the  short  space  of  twenty- 
four  hours.      When   it  was  the    fashion   to    I  leed 
largely  from  the  arm  in  pleuritis,  some  years  since, 
to  the  amount  of  100  to  200  ounces  of  blood  in  three 
or  four  days,  the  proportion  of  serum  towards  the 
last  bleedings  was  greatly  in  excess,  at  least  twice 
more  than  what  appeared  in  the  blood  first  drawn. 
And  as  regards  fibrin,  while  the  quantity  appeared 
great,  it  was  not  so,  since  it  was  thin  and  loose.    The 
proportion  of  red  globules  was  still  more  diminished. 
These  facts  were  well  known  then,  and  accurately 
explained  thus  :  the  first  ten  to  twenty  ounces  drawn 
abs    acted  equally  of  the  three  constituents  of  the 
blood,  serum,  fibrin  and  globules;    each  successive 
abstraction  took  away  equally  of  what  remained; 
but  as  fibrin  was  less  rapidly  generated  than  serum, 
it  diminished  with  each  bleeding;  and  as  regards  the 
globules,  which  require  a  long  time  to  be  created, 
they  were   greatly  less  in  number  than  any  of  the 
three  constituents,  and  in  certain  constitutions  are 
never  fully  restored.     The  volume  of  what  is  called 
blood  in  these  cases  is  restored  to  its  maximum  each 
day  by  the  fluids  drank  by  the  patient;  but  this  vol- 
ume is  not  ordinary  blood — ^it  is  diluted  blood. 


U    f! 


154 


ASIATIC   CHOLERA. 


196.  Now  observe  what  takes  place  in  cholera: 
the  very  reverse  of  what  has  been  just  mentioned. 
The  serum  is  nearly  all  quickly  drained  off;  the 
fibrin  is  decomposed,  and  scarcely  enough  remains  to 
hold  the  globules  together;  while  nearly  all  the 
globules  remain  behind.  ' 

196.  Salts  in  choleraic  blood  are  rapidly  dimin- 
ished, so  much  so  that  in  severe  or  protracted  cases 
scarcely  any  remain.  Free  alkali  is  totally  absent, 
and  the  neutral  salts  are  mostly  absent;  but  these 
salts  are  found  abundant  in  the  white  matter  dis- 
charged from  the  bowels.  ~       * 

197.  Inflammation.  From  what  has  been  stated 
it  must  appear  that  inflammation  cannot  exist  in  any 
part  of  a  choleraic  patient.  In  the  cyanosed  state  a 
blister  cannot  be  raised  by  cantharides,  nor  by  boiling 
water,  moxa  or  red-hot  iron.  In  mild  cases,  and  on 
the  turn  of  a  case,  mustard  I  have  seen  act  and 
redden  the  skin. 

198.  One  memorable  instance  of  the  headlong 
blindness  that  adheres  to  certain  schools  must  be 
mentioned.  When  cholera  invaded  western  Europe 
in  1831,  inflammation,  or  its  cousin  congestion,  was 
still  greatly  in  vogue,  and  led  practitioners  to  pre- 
scribe accordingly.  One  celebrated  professor,  Del- 
p^che,  deeply  tinctured  with  the  doctrine,  boldly 
declared  throughout  Europe  that  he  had  discovered 


PATHOLOGY. 


155 


the  seat  and  cause  of  cholera — it  lay  in  an  inflam- 
mation of  the  semilunar  ganglion.    Being  a  professor 
and  a  great  man  his  assertion  was  quickly  copied 
into   the  medical  press.    He  was  convinced  of  his 
discovery;  it  needed  only  bleeding  to  effect  a  cure. 
He  went  among  the  different  seats  of  medical  learn- 
ing demonstrating  his  discovery,  and  succeeded  in 
convincing  all  those  who  bow  in  reverence  to  a  name, 
until  he  reached  Dublin,  where,  with  a  confidence 
that  did  honor  to  his  enthusiasm,  he  would  again 
demonstrate  his  discovery  in  the  Irish  schools.    A 
subject  was  on  the  table,  he  opened   the  abdomen, 
searched  for  the  ganglion,  showed  it  in  triumph — a 
red  body — being  red  it  was,  of  course,  inflamed.   But, 
lo  1  what  a  sudden  fall  from  the  pinnacle  of  great- 
ness to    utter    insignificance  was   there  when  the 
Dublin  anatomist,  Harrison,  demonstrated  that  Del- 
peche's  ganglion    was  simply    a  lymphatic  gland, 
colored  by  stasis  (congestion);    and  by  a  further 
search   he,  Harrison,    exposed    the  real  semilunar 
ganglion,  healthy,  and  which  the  professor  of  Mont- 
pellier  had  so  often  thought  he  had  demonstrated,  but 
could  no  longer  find.     At  once  the  professor  fell  into 
deep   oblivion,  until  his   tragical  end  brought  him 
once  more  before  the  public  in  contempt  and  pity. 

199.'  The  stomach  and  intestinal  canal  are  much 
contracted,    dark    colored    from   congestion.     The 


k.t 


IB 


Hi- 

m 


m 


3! 


156 


ASIATIC   CHOLERA. 


I' 

(1 


mucous  mcmbrano  is  soft,  and  more  or  less  covered 
with  that  white  matter  wliich  ia  characteristic  of 
cholera. 

200.  The  omentum  and  intestinal  adeps  are  greatly 
diminished,  and  both  arc  dark  colored  from  stag- 
nant blood.  The  parietal  and  visceral  peritonea 
have  lost  their  clear,  shiny  appearance,  and  are  quite 
dry,  ' 

201.  The  liver  does  not  look  much  changed, 
except  being  darker  than  usual.  The  gall  bladder  is 
always  full  of  bile,  apparently  natural,  while  the 
hepatic  and  common  ducts  are  pervious  and  offer  no 
obstruction  to  its  escape.  Here  naturally  arises  the 
idea,  how  happens  it  that  the  violent  and  repeated 
straining  to  vomit  should  have  spared  the  gall 
bladder — for,  besides  being  always  found  full  at 
death,  during  life  it  poured  no  bile  into  either  the 
stomach  or  intestines. 

202.  Of  the  spleen  I  have  no  distinct  recollection, 
beyond  remembering  that  it  was  small. 

'  203.  The  kidneys  suffer  no  alteration.  The  uri- 
nary bladder  is  always  empty,  and  of  the  form  men- 
tioned in  Sec.  135. 

204.  All  the  serous  membranes,  peritoneum, 
pleura,  pericardium,  arachnoid,  are  dry.  Ascites 
and  hydrothorax,  as  well  as  hydrops  pericardii,  are 
quickly  oozed  away.    Varicose  ulcers,  and  all  other 


PATHOLOGY. 


157 


ulcers  and  sinuses,  dry  up,  but  to  return,  should  the 
patient  recover.  Two  cases  of  most  yirulent  and 
copious  gonorrhoea  ceased  at  once,  but  returned  on 
recovery  from  cholera. 

205.  The  muscles  are  harder  than  usual,  and  dry. 
On  this  account,  the  great  diminution  of  fat,  and 
very  slight  tendency  to  decomposition,  cholera  sub- 
jects answer  admirably  for  dissection. 

306.  Adipose  substance  is  greatly  diminished  in 
quantity.  A  patient  who  has  oozed  largely  by  the 
skin  quickly  grows  lean,  the  features  shrink;  in 
many  cases,  especially  of  plump,  fat-faced  girls,  the 
skin  of  the  cheeks  approaches  the  malse,  the  lips  be- 
come thin,  the  nose  sharp,  the  eyes  deeply  set  back 
into  the  orbits,  the  corneas  flaccid,  and  the  conjunc- 
tiva quite  dry.  In  one  short,  thick-set  lady  of  fifty 
years  of  age,  who,  before  the  attack,  was  remarkable 
for  a  protuberant  abdomen,  due  to  a  great  accumula- 
tion of  adeps  between  the  muscles  and  skin,  her  case 
•was  severe,  but  she  recovered  sufficiently  to  run  into 
the  "  second  stage,"  and  died  on  the  tenth  day,  when 
the  heretofore  plump  belly  was  greatly  reduced,  the 
skin  lying  in  flabby  folds.  Within  the  abdomen  the 
omentum  is  much  reduced,  the  mesentery  also,  as 
well  as  the  fat  about  the  kidneys.  In  naturally  lean 
persons  the  subcutaneous  cellular  tissue  is  tough  and 
less  easily  cut  than  in  cases  of  death  from  other 
8 


158 


ASIATIC   CHOLERA. 


causes  than  cholera.  The  heretofore  plamp  hand 
becomes  lean;  the  skin  on  the  back  of  the  hand  lies 
against  the  tendons;  the  fingers  become  lean  and 
shriveled,  like  when  long  soaked  in  water. 

207.  The  contemplation  of  this  great  waste  of 
adeps  leads  us  to  approach  the  subject  of  etiology  of 
cholera,  and  to  inquire  what  it  is  that  has  pro- 
duced this  great  change  in  so  short  a  time  as  to 
leave  so  little  fat  remaining  in  some  cases;  while  in 
all  known  diseases  fat  disappears  from  two  causes 
only:  one,  want  of  supply  through  deficient  nourish- 
ment; the  other,  it  is  removed  by  absorption — both 
slow  processes,  of  long  duration,  while  in  cholera 
the  removal  is  eflFected  in  a  few  hours,  and  without 
the  intervention  of  absorption  and  elimination. 

208,  The  itinerary  of  cholera,  and  its  attack  of 
the  healthy  only  after  they  have  been  exposed  to  one 
already  infected,  or  to  infected  materials,  clearly 
prove  that  the  immediate  cause  is  a  poison  imbibed 
by  the  patient,  who,  in  his  turn,  generates  the  same 
kind  of  poison,  capable  of  infecting  others;  but  what 
the  poison  is  like  cannot  be  demonstrated;  it  is  known 
only  by  its  effects.  Nor  can  the  contagious  principle 
contained  in  any  known  morbid  poison  be  demon- 
strated} for  instance,  the  pus  of  syphilis,  variola,  the 
exhalation  from  measles  or  scarlatina,  well  known 
diseases,  there  is  no  possibility  of  showing  it,  and  can 


PATHOLOUr. 


159 


only  bo  known  by  the  effect  it  producofl.  Wo  are 
then  forced,  in  cholera,  to  infer,  as  we  do  in  all  dis- 
eases, that  something  has  boon  introduced  into  the 
system  which  creates  the  disease.  In  the  case  of  chol- 
era, after  studying  the  phenomena  that  the  disorder 
invariably  manifests,  we  are  forced  to  believe  that  a 
poison  has  been  introduced  into  the  system,  which, 
totally  unlike  any  poison  the  product  of  disease,  pro- 
duces no  disease,  but,  instead,  a  certain  catalysis  or 
liquefaction  of  certain  elements  of  the  body,  the  na- 
ture of  which  liquid  so  prowiuced  ^as  a  r'rong  and 
rapid  tendency  to  reach  the  cutaneous  (^^.l  intestinal 
surfaces  in  a  direct  way,  ooze  throrrh  the  inter vring 
tissues,  without  the  assistance  of  ibRjrption,  circula- 
tion and  secretion — for  all  these  functions  are  abso- 
lutely suspended  in  cholera.  But  the  direct  transuda- 
tion does  not  depend  altogether  on  the  quality  of  the 
new  formed  fluid,  but  does  in  a  great  degree  depend 
on  an  unknown  change  in  the  tissues  that  give  it  pas- 
sage, is  abundantly  proved  by  the  facility  with  which 
saline  injections  escape,  almost  as  soon  as  forced  into 
the  veins — escape  in  the  same  way  as  the  choleraic 
matter  does. 

209.  The  serum  of  the  blood,  and  the  juices  con- 
tained in  the  muscles,  rapidly  ooze  out,  but  not  as 
serum;  the  fibrin  of  the  blood  is  also  drained  away, 
but  not  the  globules.    The  fat  is  removed,  but  not  in 


I 


1,' 


160 


ASIATIC   CHOLERA. 


the  quality  of  fat.  Neither  serum,  nt>r  fibrin,  nor  fat 
can  be  detected  in  the  escaped  matter,  which  is  of  a 
uniform  and  special  character,  quite  different  from 
the  materials  from  which  it  is  derived,  and  is  a  new 
creation.  Nay,  more,  the  fluid  of  dropsies,  such  as 
ascites,  hydrothorax,  hydrops  pericardii,  and,  per- 
haps, ovarian  dropsies,  also  abscess,  like  milk  abscess, 
and  that  of  fluctuating  bubo,  are  all  converted  into 
the  special  choleraic  fluid,  and  as  such  is  discharged 
from  the  system.        ^*  sf^ 

210.  We  must  then  infer  that  the  choleraic  poison, 
whatever  it  may  be,  has  the  power  of  converting  cer- 
tain constituents  of  the  body  into  a  special  liquid, 
hitherto  unknown;  also  of  converting  deposits,  the 
result  of  disease,  into  the  same.  Its  power  is  cata- 
lytic over  certain  tissues  and  deposits,  and  the  result 
is  a  coUiquation. 

211.  The  great  strides  organic  chemistry  has 
made  since  half  a  century  comes  to  our  aid,  and  fur- 
nishes us  with  analogical  facts  illustrative  of  the  mu- 
tations referred  to.       '  '  ^ 

'  212.  The  generation  of  the  choleraic  poison,  like 
that  of  all  known  morbid  poisons,  is  due  to  vital 
action  within  the  person.  It  is  more  rapidly  created 
in  some  c  institutions  than  in  others,  for  we  find  that 
a  healthy  person,  landing  in  a  contaminated  place, 
has  been  attacked  within  twelve  hours  after  expo- 


PATHOLOGY. 


161 


sure;  but,  in  tlie  majority  of  cases,  a  period  varying 
from  twenty-four  to  ninety-six  hours  intervenes  be- 
fore the  break-out.    This  poison,  like  all  morbid 
poisons,  undergoes  a  period  of  incubation,  as  it  is 
called,  before  it  can  act  on  the  patient.    The  same 
thing  occurs  in  all  cases  of  morbid  contamination. 
Inoculated  variola  takes  nine  days'  generation  in  the 
system  before  it  kindles  fover — the  subsequent  stages 
of  the  disease  being  periods  of  three  days  each. 
When  variola  is  taken  spontaneously  from  the  atmo- 
spheric contagion  there  intervenes  a  period  of  fifteen 
to  eighteen  days  of  uninterrupted  health  before  the 
commencement  of  syaxhus,  after  which  the  periods 
of  the  stages  are  similar  to  those  of  three  days  each, 
like  in  the  inoculated  cases.    Other  poisons,  such  as 
scarlatina,  measles,  etc.,  have  each  its  period  of  incu- 
bation, during  which  the  health  of  the  patient  is  not 
altered.     The  received   contagion  lies  apparently 
dormant  for  a  while,  long  enough  to  generate  the 
necessary  quality  and    quantity  of  poison  (lately 
called  ferment  or  zymosis)  to  set  up  the  same  dis- 
ease in  a  new  patient.     An  analogous  process  is 
comparatively  carried  on  in  cholera,  but  here  there 
are  no  periods  of  definite  duration;  the  only  one 
it  has  is  of  coUiquation,  arrest  of  circulation  and 
aeration. 
qS13.  We  are  forced  to  believe  that  this  poison, 


162 


ASIAWC  CfiOLERA. 


like  tlioBe  already  mentioned,  and  many  others,  does 
not  manifest  its  power  until  it  has  acquired  a  certain 
quality,  also  quantity;  for,  if  only  partially  created, 
like  in  case  of  ordinary  ferments  which  metamor- 
phose vegetable  bodies,  it  may  prove  defective  in 
quality  and  consequently  inefiScient,  or  it  may  be 
insufficient  in  quantity  to  overeome  the  resistance 
that  some  constitutions  offer  to  its  virulence.  We 
may  also  suppose  that  in  those  oases  which  run  a 
rapid  course,  terminate  suddenly  and  leave  the  pa- 
tient restored  to  health,  only  weak  for  a  day  or  two 
after,  that  the  poison  was  insufficient  to  colliquate 
the  whole  system,  like  in  bad  cases.  While  in  other 
cases  the  poison  will  be  sufficient  to  saturate,  as  it 
were,  the  system,  and  act  until  death  results;  or,  that 
the  idiosyncracy  of  the  patient  will  resist,  and  an 
end  to  the  storm  is  attnined,  leaving  an  exhausted 
economy, .  with  a  flickering  vis  medicatrix  naturae, 
which  attempts  to  make  a  cure,  or  not,  and  run  into 
"  the  typhoid  state."   - 

31 4,  We  may  suppose  or  imagine  that  the  period 
of  incubation  and  complete  generation  of  the  poison 
was  a  diseased  state  of  the  system  for  the  time  being; 
if  60,  it  is  the  only  period  in  which  disease  exists, 
though  it  is  never  manifest.  But  the  moment  the 
poison  operates,  it  causes  a  complete  cessation  of 
nearly  all  the  usual  physiological  actions — circula- 


PATHOLOGY. 


163 


tioD,  aeration,  calorification,  digestion  and  its  so- 
quents — repair  and  elimination — are  all  completely 
arrested,  while  the  cerebral  function  remains  undis- 
turbed, independently  of  the  cessations  just  named. 

315.  The  action  of  the  poison  establishes  a  coUi- 
quation  by  means  of  a  hitherto  unknown  catalytic 
cause,  in  the  total  absence  of  any  recognizable  dis- 
ease. Like  all  other  morbid  poisons,  it  selects  only 
a  certain  number  of  persons  out  of  the  whole  popu- 
lation, and  this  without  the  slightest  regard  to  the 
state  of  health  the  person  is  in  at  the  time  of  expos- 
ure, as  is  made  manifest  by  its  attacking  persons  ill 
of  fever  at  the  various  stages  of  the  fever;  regardless 
of  the  dyscrasic  taints,  such  as  syphilis,  scrofula, 
phthisis,  even  persons  under  mercurial  salivation; 
regardless  of  localities  reputed  to  be  healthy,  cleanly, 
or  otherwise,  refuting  the  ceaseless  and  senseless  cry 
against  dirty  and  filthy  places;  regardless  qf  the  trade 
or  calling  of  individuals;  regardless  of  good  or  bad 
habits — among  the  latter  drunkards,  who,  bythe-by, 
are  proved  by  statistics  to  be  more  exempt  than  ,yell 
conducted  persons.       ^ 

316.  Hitherto  I  have  avoided  speculation,  called 
by  some,  theory,  by  others,  hypotheses;  but  now,  for 
once,  will  venture  to  offer  what  follows,  not  because 
I  believe  it  is  true,  but  because  it  may  set  some  one 
thinking  how  the  poison  of  cholera  can  operate. 


164 


ASIATIC  chol::ra. 


Any  one  familiar  with  that  part  of  organic  chem- 
istry known  under  the  name  of  Compound  Elements, 
will  readily  conceive  how  a  poison  can  be  generated 
in  ihf  system,  and  being  once  formed  in  suitable 
quar^tity  may  exert  a  catalytic  power,  by  its  mere 
presence,  over  tissues  which  are  in  their  natural  state, 
and  convert  them  from  semi-solids  into  a  liquid  that 
shall  ooze  through  the  cutaneous  and  intestinal  sur- 
faces, but  not  through  serous  membranes  or  through 
any  of  the  other  mucous  surfaces,  excepting  the  intes- 
tinal. 

217.  Every  one  knows  that  a  compound  radical 
may  be  changed  into  another  one,  consisting  of  the 
same  precise  elements,  and  even  of  the  same  number 
of  atoms,  by  the  mere  presence  of  a  quite  different 
body,  which  imparts  nothing  and  abstracts  nothing 
from  the  body  it  alters.  The  only  thing  it  does  is  to 
alter  the  grouping  of  the  old  body  to  a  new  series  of 
grouping  in  the  new  body  its  presence  has  brought 
about.  Alcohol  is  converted  into  ether  by  the  pres- 
ence of  sulphuric  acid;  not  a  particle  of  the  acid  is 
given  to  either  the  alcohol  or  to  the  ether.  Sulphuric 
acid,  by  its  mere  presence,  converts  starch  into  gum 
first,  subsequently  the  gum  into  sugar,  without  com- 
bining with  either,  or  losing  a  particle  of  itself.  The 
same  conversion  of  organic  matter  is  effected  by  va- 
rious ferments.    Many  other  examples  of  the  power 


PATHOLOGY. 


165 


of  presence  are  well  known,  and  that  produced  by 
platinum  is  notorious. 

Knowing  these  facts,  we  cannot  be  surprised  to 
hear  it  stated  that  the  presence  of  the  choleraic  poison 
will  rapidly  convert  the  living  juices  and  semi-solids 
of  the  body  into  a  peculiar  fluid,  hitherto  unknown, 
which  has  the  property  of  transuding  to  and  through 
the  surfaces.  . ,  , . 

218.  Some  writers  have  asserted  that  the  gruel- 
like matter  discharged  was  the  fibrin  of  the  blood;'  but 
the  quantity  discharged  is  greater  than  the  amount 
of  fibrin  contained  in  the  blood.  On  what  imaginary 
ground  this  has  been  stated  no  one  knows,  nor  can 
it  be  proved.  No  doubt  fibrin,  as  well  as  other 
elements  and  parts  of  tissues,  is  converted  into  the 
new  liquid,  but  there  is  no  chemical  operation  that 
can  prove  the  matter  in  question  to  be  fibrin.  It  has 
none  of  the  properties  of  fibrin,  and  all  that  chem- 
istry can  do  is  to  resolve  it  into  elements  which  are 
common  to  all  animal  matter,  healthy  or  otherwise, 
consisting  of  C.  H.  0.  N, 

219.  To  sum  up  what  has  been  stated  in  this 
chapter,  it  appears  that  the  human  cosmogony,  pro- 
portioned to  the  size  of  the  system,  has  suffered  a 
cataclysm,  the  greatest  known.  A  portion  of  the 
constituent  tissues  are  suddenly  converted  into  a  new 
fluid,  an  alarmiing  coUiquation  is  the  result;  the  new 

8* 


•      JJt'l 


166 


ASIATIC  CHOLEBA. 


liquid  resists  the  confinement  presented  by  the 
envelopes  of  the  body,  makes  its  way  to  the  sur- 
face, escapes  in  profuse  quantity,  drains  the  body 
to  dryno'is,  and,  in  over  one-tlrir(-  of  the  caaes,  to 
dea^b.  It  is  a  coUiquation  not  only  of  the  W^ing 
constituents  of  tlie  body,  but  evon  of  collections  of 
matter  that  bo  longer  form  part  of  the  system— such 
as  dropsies — which  are  carried  away  out  of  thciv  re- 
ceptacles along  with  the  choleraic  avalancho.  During 
all  this  commotion  the  intellectual  systtiV  sits  serene, 
conscious  of  the  revolution,  but  helpless.  The  newly 
eroated  fluid  has  no  taste  to  the  patient,  nor  did  it 
impart  any  to  a  few  enthusiasts  who  ventured  to 
swallow  it;  it  is  destitute  of  odor,  although  a  choleraic 
patient  produces  in  his  room  a-n  indescribable  faint 
smell,  resembling  that  exhaled  from  water  in  which 
spinage  has  been  boiled.  >> 


■l:t''>i'i    '  .V.y/   f '.'-■■»'-■    iiOir'^T'.i'Mr-iJf 


,./;.■ 


V-.; 


.r<j,ioi-^'i?,    -.-^.r 


<*•!'-  y\   ,        >        t 


.H\ 


t         ■ 


CHAPTER  VII. 

TREATMENT. 

220.   A  catalogue  of  remedies  which  have  been 
used  in  cholera,  asserted  to  have  cured  nearly  eyery 


■'■i.5;K/.ip:-, 


.^A  i,  '.Iau-j     '^.f : ^'L 


patient: 

1.  Bleeding f  cupping,  leeching,  arteriotoray,  have 
cured,  in  the  practice  of  one  physician,  eighty  cases 
out  of  eighty-two.    Infallible. 

2.  Calomel,  with  or  without  opium,  in  grain  doses 
every  half  hour — in  four,  ten,  scruple,  half  drachm, 
drachm  and  two  drachm  doses,  every  half  hour,  in 
the  practice  of  certain  celebrities.    Infallible. 

3.  Emetics  of  mustard,  ipecacuanha,  emetic  tartar 
in  five  grain  doses,  kitchen  salt  in  water,  frequently. 
All  very  beneficial. 

4.  Pressure  over  the  liver.  Surely  arrests  vomiting. 

5.  Purgatives  of  castor  oil,  Glauber's  salts,  Croton 
oil,  aloes.    Highly  beneficial. 

6.  Sedatives,  as  prussic  acid,  laurel  water.  Charm- 
ing. 

7.  Euems^qfhot  water,  spirits,  {^^s^fcetida,  tobacca, 


168 


ASIATIC   CHOLERA. 


spirit  of  turpentine,  of  brandy  and  water.    Very 
beneficial. 

8.  Stimulants.  Brandy,  sulphuric  ether,  carbonate 
of  ammonia,  creosote,  strychnine,  phosphorus,  cacao- 
rum  distilled  over  horse-dung,  camphor,  capsicum, 
horse-radish,  garlic.    Many  cures. 

9.  External  heat.  Warm  baths,  hot  oats,  hot  sand, 
hot  a^hes,  a  warm  skin  fresh  from  a  sheep.  Did 
great  good. 

10.  Ice  on  the  spine  and  back.    Excellent. 

11.  Astringents.  Sulphate  of  copper,  acetate  of 
lead,  nitrate  of  silver  in  pills,  muriated  tincture  of 
iron,  lime  water  with  milk,  extract  of  catechu.  All 
beneficial.  , 

12.  Drinks  of  brandy  punch.     Cured  many. 

13.  Acupuncture  of  the  heart.    Uncertain. 

14.  Galvanism.    Useless. 

15.  Quinine  cured  like  in  ague.     Good. 

16.  Charcoal.    A  sovereign  remedy. 

17.  Subnitrate  of  bismuth.    Phosphorus. 

18.  External  or  revulsive  applications.  Scalding 
water,  cantharides,  strong  nitric  acid  over  the 
stomach,  moxas,  red-hot  iron,  heated  hammers  and 
laundry  irons  rubbed  up  and  down  the  back.  Pro- 
duced great  eflfect, 

19.  Laughing  gas  inhaled,  oxygen  gas  inhaled, 
also  drank  in  impregnated  water.    Useless.         : 


i,ti 


TREATMENT. 


169 


20.  Saliuc  injections  into  the  reins. 

21.  Opium  variously  combined,  etc.,  etc.,  etc. 


The  foregoing  list  of  heterogeneous  remedies  is 
not  the  production  of  quacks,  but  was  seriously  pub- 
lished, strongly  recommended  by  practitioners  of 
eminence,  and  who,  to  say  the  least,  ought  to  have 
known  better  than  to  publish  their  conceits,  and 
ought  now  to  blush  at  their  errors. 

221,  If  ever  humanity  were  entitled  to  pity  for' 
Bufferings  created  by  errors,  the  growth  of  a  false 
science,  it  is  surely  in  the  caae  of  cholera,  as  a  glance 
at  the  remedies  and  treatment  employed  mentioned 
in  the  foregoing  list  would  indicate.  Very  few  prac- 
titioners have  had  the  conscience  to  avow  that  they 
were  at  a  loss  what  to  do,  and  had  also  the  courage 
to  resist  the  impr  rtunities  of  interested  persons 
urging  them  to  "  do  something."  A  majority  of 
practitioners  went;  to  work  in  a  case  of  cholera 
trying  one  thing  o\*  anything;  and  should  the  patient 
survive  both  the  pest  and  the  remedy,  they  would 
hasten  to  publish  a  cure  effected  by  an  infallible 
mode  of  treatment.  After  repeated  failures,  they 
would  jump  to  another  means  as  senseless  as  the  first 
one;  and  now,  forgetting  the  late  asserted  cures, 
proclaim  the  last  one  infallible  also  I  In  this  way 
has  the  profession  been  disgraced.  ^ 


170 


ABtlTIO  CHOLERA. 


*/ 


232.  It  is  easy  to  perceive,  through  the  mist  rising 
from  the  catalogue  of  remedies  just  cited,  where  lay 
the  root  of  a  false  medication.  The  mind  of  a  student 
receives  a  bend  suited  to  nosology,  the  symptoms  and 
treatment  as  laid  down  in  books,  and  which  he  finds 
confirmed  by  a  most  imperfect,  coarse  and  erroneous 
physiology,  grown  out  of  a  mixture  of  descriptive 
anatomy  and  shallow  chemistry.  Thus  endowed  he 
feels  himself  ready  to  combat  any  disorder,  and  that 
he  is  armed  with  a  knowledge  of  every  thing  per- 
taining to  medicine — known  and  unknown.  He 
never  ouce  notices  the  conflict  of  dogmas  that  cease- 
lessly rise  up  in  his  path,  unless  it  is  to  reconcile  or 
refute  them,  always  to  his  own  satisfaction,  and 
never  to  that  of  a  co-l^l^orpr.  He  has  the  faculty  of 
argumentation.  When  he  is  at  a  loss  for  a  method 
of  treatment,  he  soon  finds  one,  founded  on  analogies, 
whether  the  supposed  analogy  suits*  or  not.  Hence 
the  wild  range  of  his  fancy,  to  which  he  bows  with 
complacent  respect,  adapts  something  to  suit  some- 
thing, right  or  wrong;  who  is  to  judge?  Not  the 
patient,  or  if  he  or  others  do,  his  acquired  facility 
of  argumentation  and  explanation  will  carry  him 
through  in  triumph,  to  his  own  satisfactiop,  if  not  to 
that  of  others. 

Thus  armed,  he  attacks  cholera  as  he  would  disease 
as  described  in  nosology,  not  once  dreaming  that 


TREATMENT. 


171 


nosological  disease  does  not  exist  in  cholera.  He 
brings  a  treatment  founded  on  analogies,  but  which 
do  not  exist  in  reality  in  cholera.  His  patient 
vomits — he  administers  carminatives,  to  soothe  a 
Stomach  that  is  not  disordered  in  itself;  his  patient 
has  profuse  purging,  when  the  purging  treated  of  in 
nosology  does  not  exist — ^he  adminsters  astringents; 
his  patient  transpires  profusely — this  he  dare  not 
attack,  for  now  he  is  confused;  the  heart  and  pulse 
are  feeble,  the  latter  extinct — he  prescribes  stimu-- 
lants  to  organs  that  cannot  be  roused  by  stimulants; 
his  patient  is  cold — he  will  apply  external  heat  that 
cannot  penetrate  to  the  interior;  the  stomach  is  still 
irritable — he  will  apply  revulsives  where  metastasis 
cannot  take  place;  he  will  excite  a  "  new  action  in 
the  system"  founded  on  the  theory  that  two  diseases 
cannot  exist  at  the  same  time;  he  gives  calomel  for 
this  purpose,  a  substance  which  is  perfectly  inert  in 
the  actual  and  wonderful  state  of  the  system. 

233.  Let  us  now  do  as  was  done  with  the  symp- 
toms, examine  them  in  detail,  and  the  treatment  and 
remedies,  each  by  itself,  and  discover,  if  we  can,  the 
discrepancies  we  shall  meet  with. 

Abstraction  of  Uood.  When  contagious  cholera 
broke  out  in  India,  the  prevalent  idea  of  the  nature 
of  the  disease  was,  if  not  inflammatory,  there  was 
at  least  congestion  somewhere.    At  that  time  bleed- 


»  i 


172 


ASIATIC    CnOLKiLi. 


ing  was  the  battle-horse,  and  often  had  recourse 
to,  if  only  for  fashion's  sake.  Accordingly  wo  find, 
in  the  first  years  of  the  pestilence,  almost  every  prac- 
titioner drawing  bloody  urging  the  practice  in  publi- 
cations, and  citing  numerous  cures.  They  advised  to 
bleed  to  the  extent  of  thirty  ounces,  if  that  quantity 
can  be  had;  if  not,  get  as  much  as  you  can;  and  as 
the  blood  soon  becomes  thick  and  flows  with  reluc- 
tance, open  the  vein  as  early  as  possible,  while  the 
heart  has  still  power  to  act,  and  the  blood  not  too  much 
inspissated  to  flow.  If  phlebotomy  gives  no  blood, 
apply  cups;  if  cups  give  none,  try  leeches;  if  all  these 
fail,  try  arteriotomy.  Some  practitioners  declared 
that  under  the  sanguinary  treatment  they  cured  nine 
out  of  ten  cases;  others  cured  nineteen  out  of  twenty; 
and  Dr.  Barrel  eighty  out  of  eighty-two  cases,  all  by 
bleeding  1  Other  practitioners  were  less  fortunate, 
soon  saw  the  error  and  opposed  it; 'but  still  the  prac- 
tice prevailed  for  several  years,  even  until  the  pest 
reached  Europe  in  1830,  and  after,  by  those  routinists 
who  can  never  get  out  of  a  beaten  track. 

224:.  We  find,  from  the  very  beginning  of  an  attack 
of  cholera,  that  all  venous  capillary  action  is  greatly 
arrested,  if  not  quite  stopped,  and  that  the  vigor  of 
the  heart  diminishes  rapidly.  The  volume  of  blood 
is  soon  reduced  by  the  oozing  out  of  the  serum  and 
much  of  the  fibrin,  leaving  the  globules  behind.    Can 


■4 


TREATMENT. 


1T3 


bleeding  arrest  or  restore  the  losi,  or  re-establish  the 
natural  proportions  of  serum,  salts,  fibrin,  and  the 
quality  of  the  globules?  No.  Besides,  blood,  like  the 
tissues,  is  subject  to  the  colliquative  force  of  the  poi- 
son, and  is  itself  inert,  receives  nothing,  communicates 
nothing,  and  of  course  is  a  passive  body.  Hence  it  is 
that  inflammation  has  never  been  excited,  and  cannot 
be  kindled  by  any  amount  of  irritation  during  the  chol- 
eraic stage.  Will  bleeding,  then,  orrest  an  inflammation 
that  cannot  and  does  not  exist  ?  Absurd.  Experience' 
has  at  last  forced  the  advocates  of  bleeding,  and  tho 
routine  practitioners,  to  abandon  this  gross  error. 

235.  Calomel  is  the  next  heroic  remedy,  which,  in 
India,  appears  to  have  been,  as  it  were,  a  household 
necessity,  to  be  administered  in  every  and  all  kinds 
of  disease.  Given  as  a  mere  laxative,  as  a  dcpurative 
of  bile  and  other  hflmors,  or  with  a  higher  view,  under 
the  theory  of  inducing  a  change  in  the  constitution 
for  a  time  by  establishing  a  new  disease,  which  is  to 
supplant  the  first  one  and  expel  it,  under  the  dictum 
that  "  two  diseased  actions  cannot  exist  together." 
Leaving  the  theory  to  defend  itself,  let  us  endeavor  to 
ascertain  whether  there  exists  the  remotest  or  slight- 
est probability  that  the  drug  can  be  absorbed  into  the 
system;  if  not,  it  must  prove  useless.  When  practi- 
tioners had  recovered  from  the  alarm  and  confusion 
of  ideas,  and  commenced  slowly  to  observe  the  phe- 


174 


ASIATIC   CHOLERA. 


nomena  produced  by  the  poison,  it  was  discovered 
that  absorption  was  completely  arrested;  consequent- 
ly, calomel  might  be  conveyed  into  the  stomach,  but 
could  not  enter  the  system.  Besides,  it  was  moreover 
discovered  that  circulation  was  also  arrested;  so  that, 
if  even  mercury  were  absorbed,  it  could  not  be  car- 
ried through  the  system.  So  potent  were  a  wrong 
education,  a  defective  physiology,  a  badly  acquired 
habit,  a  blind  faith  in  false  doctrines,  and  a  perni- 
cious obstinacy  in  adhering  to  habit,  that  almost  all 
physicians  made  use  of  calomel.  One  gave  a  grain, 
with  or  without  opium,  every  half  hour;  another  two 
to  five  grains;  finding  these  doses  inefficient,  ten  to 
twenty  grains;  others,  bolder,  gave  half  drachm,  one 
and  two  drachm  doses.  Should  one  or  two  patients 
out  of  three  (the  average  number)  recover,  the  recov- 
eries were  boasted  of  as  cures.  I'or  a  long  time  the 
small  dose,  the  medium,  and  the  heroic  dose  doctors 
published  how  successful  was  their  practice.  In  time, 
however,  this  abuse  of  calomel  declined,  but  is  not 
yet  extinct  among  that  numerous  class  of  practition- 
ers who  cannot  rise  above  the  grade  of  routinists  or 
mere  medicasters. 

226.  Metastatic  treatment.  The  theory  of  metas- 
tasis, an  ancient  one,  not  altogether  false,  is  still 
prevalent,  and  comes  as  a  kind, too  often  a  cruel  aox- 
iliary  to  the  practitioner  who,  when  at  his  wit's  end 


r. 


TREATMENT. 


175 


for  means,  calls  in  the  aid  of  his  friends — revulsives— 
in  the  hope  that  they  will  translate  a  malady  to  the 
surface,  if  not  quite,  yet  in  some  proportion.  To 
leave  nothing  undone,  even  when  nothing  can  be 
done,  sinapasms,  cantharides,  cauteries,  and  every 
imaginable  means  capable  of  irritating  and  injuring 
the  surface,  have  been  employed  without  stint.  When 
employed  early,  which  is  rarely  the  case— that  is, 
before  the  surface  has  become  quite  cold  and  the 
capillaries  stagnant,  as  announced  by  cyanosis— these 
means  may  act  slightly  on  the  skin,  for  a  very  short 
time, should  the  case  be  a  slow  one;  soon,  however,  to 
be  arrested,  as  all  other  actions  are,  by  the  cataclysm 
induced  by  the  poison.  But  in  most  cases  the  length 
of  time  claimed  by  all  epispastics  to  act  is  longer  than 
the  collapse  will  permit,  and  vesication,  if  useful,  can- 
not take  place.  Why,  then,  torment  the  patient  with 
them? 

A  more  energetic  metastatic  means  has  been 
had  recourse  to — scalding  water,  as  an  instantaneous 
means;  red-hot  iron,  by  French  practitioners  indoc- 
trinated to  this  cruelty  by  the  combustible  old  Larrey? 
also  his  moxas;  by  the  Germans,  such  delicate  instru- 
ments as  burning-hot  hammers  and  laundry  irons 
promenaded  down  each  side  of  the  spine  and  back; 
strong  nitric  acid  applied  over  the  stomach  1  Was  I 
wrong  when  I  said  the  choleraic  weie  entitled  to 


176 


ASIATIC  CHOLEBA. 


pity  for  the  sufferings  inflicted  by  dogmatic  practi- 
tioners? It  is  fortunate  for  the  victims  of  such  mon- 
strous cruelties  that  none  recovered  to  endure  the 
protracted  suffering  that  wide-spread  sloughing 
would  induce.  If  any  of  these  patients  recovered  it 
is  unknown,  and  the  heroic  doctors  have  kept  silent 
regarding  the  ultimate  destruction  that  their  bar- 
barity must  have  created,  had  it  been  possible  for 
man  to  resist  the  first  effects.  Yet  many  of  the 
medical  heroes  had  the  hardihood  to  declare  that 
their  treatment  was  good,  and  did  cure. 

228.  Emetics  to  arrest  vomiting.  The  signal  ben- 
efit of  an  emetic  in  cases  of  saburra,  and  at  the  com- 
mencement of  fevers,  suiggested,  no  doubt,  the  idea  of 
"  clearing  out  the  stomach,"  and  in  this  way  remove 
peccant  matter,  which  caused  the  vomiting.  Had 
the  majority  of  remedies  administered  in  cholera 
been  as  reasonably  founded  on  derived  experience,  no 
great  censure  could  attach  to  the  practice;  but,  un- 
fortunately, the  peccant  matter  is  renewed  as  fast  as 
it  is  ejected,  and  as  long  as  the  system  can  furnish 
material  for  coUiquation;  but  the  case  bears  no  an- 
alogy to  those  in  which  emetics  are  useful. 

Tartrate  of  antimony  was  one  of  the  forms  of 
emetic  employed  and  praised,  given  in  five  grain 
doses,  repeated.  Such  a  dos  is  astounding,  and 
finds  no  place  in  practice,  excepting  in  the  Italian 


TREATMENT. 


17T 


practice  wherein  it  was  so  administered,  not  to  clear 
the  stomach,  for  such  a  dose  does  not  excite  vomit- 
ing, but  to  produce  such  an  arrest  of  circulation  and 
nervation  (the  new  word  is  innervation)  as  will  sub- 
due pleuritic  inflammation,  against  which  it  was  em- 
ployed with  benefit.  But  cholera  is  neither  pleuritis 
nor  other  inflammation,  nor  a  disease,  as  has  already 
been  explained.  Ipecacuanha,  mustard,  and  kitchen 
salt,  frequently  repeated,  although  an  erroneous  prac-, 
tice,  is  not  deleterious  and  astounding  like  antimony. 

229.  Pressure  over  the  liver ^  to  arrest  vomiting, 
was  recommended,  with  what  effect  is  not  mentioned, 
nor  on  what  principle  is  it  possible  to  imagine — 
although  in  this  instance,  like  in  many  others,  there 
are  metaphysical  abstractionists  who  are  ever  ready 
to  explain  any  thing,  if  it  be  only  absurd  enough. 

230.  Purgatives  were  had  recourse  to  and  recom- 
mended. They  could  do  no  other  harm  than  what  is 
due  to  the  annoyance  of  swallowing  them  and  their 
immediate  rejection  upward,  adding  to  the  distress 
of  the  patient  and  iuTeasing  his  exhaustion.  But, 
were  it  possible  for  the  purgative  to  lie  on  the  stom- 
ach and  reach  the  intestinal  canal,  it  could  not  come 
in  contact  with  the  mucous  membrane,  which  is  in  a 
ceaseless  state  of  oozing,  a  state  that  will  protect  its 
surface  from  the  remedy;  besides  that,  as  all  physio- 
logical action  is  here  arrested,  a  purgative,  even 


178 


ASIATIC   CHOLERA. 


could  it  reach  the  mucous  surface,  would  not  excite  a 
purgative  secretion. 

Castor  oil,  aloes,  Glauber's  salts,  Croton  oil,  ox 
gall,  were  the  purgatives  employed. 

231.  Antispasmodics  were  called  into  service— on 
what  ground  no  ra,tional  mind  can  conceive;  but  the 
practice  can  be  defended  and  explained  by  routinists, 
who  have  the  faculty  of  explaining  things  known 
and  unknown,  right  or  wrong.  Among  these  reme- 
dies are,  or  were,  musk,  cajeput  oil,  guaicum,  asa- 
foetida,  hartshorn,  valerian,  or  any  thing  that  has  a 
bad  odor. 

232.  Sedatives — Prussic  acid,  laurel  water,  opium; 
but  of  this  last  see  hereafter. 

233.  Enemas — ^not  able  to  do  good  per  oram,  some 
practitioners  descended  ad  infra  to  operate  per 
anum.  Accordingly,  enemas  containing  asafoetida, 
castoreum,  spirit  of  turpentine,  alcoholic  spirits, 
even  tobacco,  have  been  recommended  and  used;  and 
fortunately  the  tobacco  has  been  rejected  as  soon  as 
injected,  else  it  would  add  a  new  collapse  to  that 
which  the  patient  can  no  longer  bear  up  ajjainst. 

234.  Stimulants  have  been  largely  had  recourse 
to,  and  might,  by  judicious  management,  prove  an 
auxiliary  to  other  means;  but  they  require  a  moat 
careful  watching.  Sulphuric  ether  alone,  and  with 
ammonia,  carbonate  of  ammonia  in  five  grain  doses, 


TREATMENT. 


179 


creosote,  strychnine  have  been  given;    phosphorus 
also — here  I  must  stop  a  moment  to  say  what  I  have 
seen  done  with  phosphorus.    It  was  recommended  in 
the  Edinburgh  Journal  to  give  pills  of  phosphorus, 
made  by  beating  phosphorus  and  bread-crumb  under 
water  into  a  mass  and  making  it  into  pills.    An  old 
gentleman  caught  the  idea,  made  some  and  gave  them. 
His  son,  a  dashing  new  light,  disdained  trammels, 
saw  no  necessity  for  following  the  laborious  method 
of  his  father,  but  attained  the  same  end  by  simply 
cutting  sticks  of  common  phosphorus  into  chunks. 
He  carried  these  pieces  with  him  in  a  vial  in  water. 
As  I  was  passing  a  house  in  a  garden,  a  woman 
standing  at  the  gate  asked  me  to  walk  iu  and  see 
her  husband,  Wm.  Harrison,  sexton  to  the  English 
burying  ground.    I  found  him  in  collapse,  quite  sen- 
sible.   The  young  doctor  followed  me  in,  who,  with- 
out ceremony,  said,  "  My  dear  fellow,  V\\  cure  you  at 
once.    Open  your  mouth;  I'll  poke  these  pills  down 
your   throat — they'll    cure    you."    Accordingly  he 
took  out  of  his  bottle  about  ten  pieces  of  phosphorus 
of  at  least  two  grains  each,  which  he  did  "  poke" 
into  the  pharynx.    How  the  remedy  acted  I  did  not 
stay  to  see;  but  he  died  8,  few  hours  after.    This 
man  had  gone  unscathed  thi'ough  the  whole  of  1832, 
fend  was  daily  at  work  convoying  dead  to  the  ground 
and  burying  them.    He  passed  through  the  greater 


\  \ 


180 


ASIATIC    CHOLERA. 


part  of  the  cholera  of  1834,  but  was  attacked  August 
7th,  died  the  same  day,  aged  54. 

Opium  with  camphor,  opium  ia  large  doses,  recom- 
mended by  Dr.  Tweedie,  who  ought  to  have  known 
better,  and  who  at  last  said  while  it  did  good  it 
hastened  death.  Camphor,  capsicum,  horse-radish; 
brandy  alone  will  cure,  said  Dr.  Leo,  of  Vienna ; 
especially  cacao-brandy,  distilled  over  horse-dung, 
called  Tangara.  Dr.  Kiven's  infallible  Vienna  reme- 
dy, which  cured  all  bat  two  out  of  242  cases,  was  com- 
posed as.  follows  :  one  pint  of  spirits,  half  a  pint  of 
vinegar,  one  ounce  of  camphor,  two  drachms  of  pep- 
per and  one  ounce  of  garlic — a  teaspoonful  to  be  taken 
frequently. 

Practitioners  who  have  a  predilection  for  stimulant 
medicines  of  a  carminative  class,  such  vs  sulphuric 
ether,  might,  perhaps,  substitute  chloroiurm  in  five  to 
ten  minim  doses  in  a  little  water,  internally,  since  it 
is  agreeable  to  take,  and  as  good  a  stimulant  as  ether. 
But  not  by  inhalation;  for,  should  it  permeate  the 
lung-tissue,  which,  in  cholera,  is  not  likely,  it  would 
tend  to  paralyze  the  heart  in  an  additional  degree. 
Besides,  chloroform  in  the  stomach,  like  carbonic  acid 
gas,  produces  ihe  opposite  effect  to  what  occurs  in 
inhalation. 

235.  Warm  haths,  also  dry  heat  afforded  by  hot 
oats,  hot  sand,  hot  chalk  in  powder,  hot  ashes,  and,  as 


TREATMENT. 


181 


a  contrast  of  consistencj,  ice  on  the  spine,  and  cold 
baths. 

236,  Afitnngents.  Sulphate  of  copper,  by  no  less 
a  character  than  the  great  Dupuytren,  nitrate  of  sil- 
ver in  pills,  acetate  of  lead,  muriated  tincture  of  iron, 
lime  water  and  milk,  magnesia,  subnitrate  of  bismuth 
in  four  grain  doses,  extract  of  catechu. 

237,  Drinks.  Warm  water,  cold  water,  ad  lihi- 
tum;  by  others,  none  at  all;  brandy,  pure  or  as  punch; 
effervescing  draughts. 

238,  Acupuncture  of  the  heart,  by  Dr.  Searl,  at 
Warsaw,  one  of  the  commission  sent  thither  to  in- 
quire into  the  pest  and  report  upon  the  best  treat- 
ment. He  was,  of  course,  a  respectable  practitioner, 
but  this  conduct  proved  him  to  be  a  crazy  man;  by 
the  same,  galvanism;  he,  however,  says,  correctly,  that 
this  last  is  of  no  service. 

239,  Quinine,  per  or  am  et  anum.,  has  been  ad- 
ministered by  routine  practitioners,  who  had  not 
strength  to  move  out  of  the  beaten  track  of  nosology, 
and  who  compared  an  attack  of  cholera  to  one  of 
ague,  supposed  that  the  collapsed  state  was  the  cold 
stage,  and  the  weak  attempt  of  nature  to  recuperate, 
called  the  typhoid  state,  was  the  hot  stage.  What 
can  be  done  with  such  minds  ?  Quinine  was  also  given 
in  enemas  when  it  could  not  be  retained,  and  even 
injected  into  the  veins. 

9 


182 


ASIATIC   CHOLERA. 


240.  Charcoal  made  from  burnt  corks  is  .  eported 
to  have  been  uped  on  board  of  a  United  States  frigate 
in  India,  most  likely  as  an  antiseptic.    This  idea  was 
caught  up  by  an   extraordinary  man,  poor,  philan- 
thropic, ignorant  and  zealous.    He  appears  suddenly 
in  Montreal,  soon    after  the  outbreak,  accompanied 
with  his  inseparable  companions — a  lean  mare  and 
two  grown-up  colts;  these  followed  him  wherever  he 
went,  like  docile  dogs.    His  services  were  gratuitous, 
kind  and  modest.    In  a  short  time  he  was  looked 
upon  by  the  poor  as  a  saint  from  heaven,  and  got  the 
name  of  Saint  Roch,    His  remedy  was  equal  parts  of 
powdered  wood  charcoal,  hogs'  lard  and  maple  sugar. 
Of  this  disgusting  medley  was  to  be  taken  as  much  as 
could  be  swallowed;  an  addition  was  made,  consisting 
of  a  pailful  of  cold  water  and  wood  ashes,  with  which 
the  feet  and  legs  were  bathed.    This  lye  he  rubbed, 
or  caused  to  be  diligently  rubbed  into  the  skin,  as 
high  up  as  to  the  knees.    I  saw  him  at  work  in  the 
case  of  a  tall,  lean  old  man,  whose  skin  over  the  tibia 
appeared  to  be  dissolved  and  rubbed  away.    This 
man  was  a  wealthy  and  respectable  publican,  George 
Wurtele,  about  sixty  years  of  age.    He  sat  in  a  chair 
during  the  treatment,  quite  conscious,  and  died  the 
game  day,  after  a  few  hours' illness. 

241.  Oxygen  gas  wau  had  recourse  to,  suggested 
by  the  absence  of  aeration  of  the  blood.    It  was  both 


TREATMENT. 


183 


!  * 


inhaled  and  drank  in  water  saturated  with  it,  also  in 
aaturated  water  injected  into  the  rectum,  but  proving 
of  no  avail,  was  soon  abandoned.  Nitrous  oxyde 
gi'^;  was  used  in  ilie  same  way  with  the  same  results. 

S-ili.  In  1848  chloroform  was  administered,  inter- 
nally, with  beneficial  effect,  I  was  told;  but  of  myself 
I  have  no  knowledge  of  its  use. 

243.  Saline  venous  injections.  The  able  and 
graphic  description  of  a  case  of  cholera  by  Dr. 
O'Shaughncfcisy,  and  his  analysi^of  the  blood  and  dis- 
charges, led  to  his  first  suggestion  of  the  injection  of 
a  solution  of  nitrate  or  chlorate  of  potash,  as  being 
highly  oxygenated  salts  and  likely  to  act  on  the 
globules;  but  it  does  not  appear  whether  or  not  it 
was  put  into  practice.  Dr.  Clanny,  of  Sunderland, 
also  threw  considerable  light  on  the  chemistry  of 
cholera.  But  the  first  one  to  avail  himself  of  inject- 
ing salts  into  the  veins  was  Dr.  Latta,  of  Leith, 
Scotland.  His  solution  was  composed  of  chloride 
of  soda,  two  di  jchms,  carbonate  of  soda,  two  scru- 
ples, white  of  egg,  and  water,  four  pints.  He  in- 
jected in  the  beginning  of  his  operations  from  five  to 
ten  pounds,  repeated  at  short  intervals;  but  seeing 
the  impunity  with  which  this  foreign  matter  could  be 
introduced  into  the  vessels,  he  grew  bolder,  until  he 
and  many  others  injected,  without  stopping,  330 
ounces  in  the  space  of  twelve  hours.     Thirty-one 


184 


ASIATIC   CHOLERA. 


pints  were  iiyccted  into  a  patient  in  the  srace  of 
throe  hours.  As  much  as  six  hundred  ounces  have 
been  injected  at  a  tcmperatun  of  112°,  116*,  124°, 
but  oozed  out  cold  per  cutem  et  anum.  However,  it 
was  soon  ascertained  that  it  gave  no  permanent 
benefit. 

244.  The  effect  of  the  injection  was  of  the  most 
marvelous  character,  and  often  struck  non-profes- 
sional beholders  with  awe.  A  patient  lying  in  the 
collapsed  state,  lean  and  cold,  and  often  manifesting 
no  consciousness,  moribund,  would,  as  the  injecting 
progressed,  gradually  fill  out,  improve  in  color,  open 
and  shut  the  lids,  and  sometimes  speak.  Dr.  Tweedie 
mentions  three  wonderful  cases,  which,  after  being 
resuscitated,  as  it  were,  got  up,  conversed  jocularly, 
bat  all  at  once  fell  into  collapse  again  and  suddenly 

di(:d. 

245.  Transfusion  was  in  some  cases  added  after 
the  saline  iivjection,  but  no  good  came  of  it. 

The  idea  of  injecting  salines  was  with  a  view  to 
oxygenate  the  blood,  and  on  that  account  O'Shaugh- 
nessy  suggested  highly  oxygenated  neutral  salts;  but 
Latta  employed  carbonated  salts,  and  others  fol- 
lowed his  example — ^yet  the  effect  was  marvelous. 
Soda  or  any  neutral  salt  will  redden  the  blood. 

246.  Personal  experience,  I  shall  cite  only  two 
cases  out  of  many.    A  chambermaid,  a  beautiful  girl, 


TBEATMENT. 


185 


much  admired  for  her  plumpness  and  fine  color, 
about  twenty  years  of  age,  lived  at  the  Brock  Hotel, 
Montreal.  While  in  the  cyanosed  and  collapsed 
state,  lean  and  shriveled,  especially  the  fingers  and 
hands,  but  possessi  1  of  her  senses,  Dr.  Stephenson 
injected  into  thf>  basilic  yein  of  one  arm  five  or 
six  pints  of  sn  ^'lid ;  gradually  her  face  filled 
out,  her  cheel  u  .?  •»  once  more  rosy,  her  dry 
and  sunken  eyeb  uecai  e  moist  and  bright,  and  less 
deeply  sunken  into  the  orbits;  her  voice  became  less 
husky — altogether  she  seemed  restored,  but  a  shiver- 
ing came  over  her  and  she  soon  died.  This  was  the 
first  case  I  saw. 

247.  Another  case.  I  was  invited  to  see  Drs. 
Arnoldi,  Senior  and  Junior,  inject  Mr.  Oliver  Wait, 
on  Sunday,  at  noon,  August  21st,  1832.  He  was 
about  forty-five  years  of  age,  a  very  strong  and  mus- 
cular man,  much  given  to  daily  active  exercise  in  the 
open  air.  I  found  him  lying  on  his  back,  apparently 
dead,  excepting  the  quiet  respiration  manifested  by 
the  slow  movement  of  his  chest.  Vomiting,  purging, 
and  oozing  out  by  the  skin  had  completely  ceased; 
his  skin  was  cold,  leaden  color,  but  that  of  the  face, 
tanned  by  habitual  exposure,  was  rather  brown  than 
blue;  his  face  was  now  sharp  and  lean;  his  eyes  deep 
sunken  in  the  orbits ;  the  lids  partly  open^  and 
immovable;  the  eye  was  quite  dry  and  the  cornea 


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WEBSTER,  N.Y.  14580 

(716)  872-4503 


180 


ASIATIC   CHOLfiRA. 


flattened;  his  moutli  was  sHglitly  open;  house  flies 
crawled  in  and  out  of  the  lips,  into  the  nostrils  and 
out,  and  over  the  exposed  part  of  the  eyes,  without 
exciting  the  least  perceptible  winking.  Such  was  his 
state  when  the  old  doctor  had  finished  making  two 
large  wash-bowls  of  saline  fluid,  and  his  son  had 
Inserted  the  tube  into  the  basilic  vein  of  his  left  arm. 
All  being  ready,  the  old  gentleman  said  to  me,  "  You 
do  not  countenance  this  treatment;  here  is  an  extreme 
case;  you  shall  soon  see  him  restored."  He  com- 
menced to  inject  by  means  of  a  Reed's  pocket  brftss 
syringe,  capable  of  discharging  about  twelve  drachms 
at  a  stroke  of  the  piston.  He  worked  on  deliberately 
and  ceaselessly  until  the  first  bowlful  was  licarly  used 
before  any  apparent  effect  became  noticeable;  at  last 
the  color  of  the  cheeks  became  lighter,  the  face  looked 
a  little  fuller,  and  the  malse  less  prominent;  next, 
the  eyes  became  moist,  and  much  less  dim,  but  the 
lids  did  not  move ;  his  respiration  was  regular 
as  heretofore,  but  much  more  expanded.  At  the 
last  of  the  second  bowlful  the  lids  opened  com- 
pletely; he  stared  at  us,  but  did  not  wink,  nor  did 
he  make  the  least  motion,  nor  attempt  to  speak;  his 
skin  grew  moist,  but  remained  cold,  although  the 
injection  was  at  112^;  and  at  last  we  heard  a  gush 
from  the  bowels,  soon  followed  by  an  exceedingly 
strong  rigor.  The  young  doctor  exclaimed: "  We  have 


TREATMENT. 


187 


established  the  ague  stage;  send  for  quinine  1"  In  a 
few  momenta  more  he  ceased  to  breathe,  and  was 
dead.       .     •   ■  •  ■  "  ■-•  .:    '  "  "    ■  .--■"--••'•. 

The  moribund  state  of  this  strong  man  before  the 
injection  and  his  sudden  apparent  recovery,  gave  to 
many  of  the  bystanders  the  idea  of  a  ghostly  resurrec- 
tion of  a  corpse;  some  of  them  left  the  room  in  terror. 
In  me  it  excited  the  sentiment  of  a  total  refutation 
of  the  doctrines  of  physiology — a  dead  man  brought 
back  to  life,  as  it  were,  by  merely  filling  the  vessels 
with  a  fluid  not  natural  to  the  body.  The  heart  was 
once  more  set  agoing,  and  a  feeble  pulse  could  be  felt 
at  the  wrist;  the  mind  once  more  restored — some 
thought.  Can  a  recently  dead  man  be  restored  to  life 
— at  least,  will  these  experiments  be  improved  upon 
and  made  available  in  disease  ? 

248.  Having  completed  a  critical  review,  I  hope 
with  candor  and  honesty,  of  most  of  the  remedies  and 
modes  of  treatment  recommended  in  cholera  up  to  the 
period  this  sketch  treats  of,  that  is,  t<.  1834, 1  have 
only  to  add  one  advice — ^look  at  the  heterogeneous 
kinds  of  incompatibles  in  the  quoted  catalogue,  many 
of  them  still  in  use,  each  opposed  to  each,  and  nearly 
all  useless,  often  injurious  I 

It  is  with  a  faint  pleasure  I  come  to  notice  and 
remark  upon  anbther  class  of  remedies  that  do  not  re- 
volt our  common  sense,  and  which  have  proved  to  be 


188 


ASIATIC  CHOLEEA. 


great  auxiliaries  to  nature — in  many  cases  have  con- 
tributed a  fair  share  towards  the  recovery  of  some 
patients,  and,  when  judiciously  employed,  injurious  to 
none. 

249.  Opiunit  first  of  all.  Sydenham  said:  "  With- 
out opium,  all  medication  would  be  imperfect  and 
insufficient/^  Its  effect  is  often  decisive  of  life  or 
death;  used  at  the  critical  moment  it  will  save,  and 
as  surely  will  destroy  if  wrongly  applied;  is  unique 
in  its  operation,  and  cannot  be  replaced  by  any  other 
remedy;  has  reigned  for  more  than  a  thousand  years 
despot  over  the  medical  world,  and  spread  benefits  as 
well  as  ruin  over  humanity;  it  is  a  double-edged 
sword,  a  divine  gift  in  the  hands  of  a  master,  a  poison 
in  those  of  a  mere  routinist — a  medicaster — a  demi- 
physician.  Sacra  vitce  anchora,  circumspede  agenti' 
hu8,  est  opium;  cymba  vero  Charontis  in  '^inu  im- 
jperitiJ*  _-    ^,_    _.,.  ^  ,._^,  ^.. ;..  .  ,.,,;.!:.:,__ 

Throughout  the  whole  reign  of  cholera  opium  has 
been  had  recourse  to,  with  benefit  when  judiciously 
employed;  but  which,  alas,  has  seldom  been  the  case, 
for  there  are  only  a  few  practitioners  who  are  deeply 
versed  in  the  recondite  action  of  this  heroic  remedy 
while  the  great  majority  see  in  it  only  an  every-day 
drug,  and  are  totally  ignorant  of  its  mysterious  power. 
This  is  a  severe  judgment,  but,  unfortunately,  a  true 
one,    In  describing  common  cholera.  Sees.  92  and  96, 


V  ". 


:.V 


TREATMENT. 


189 


97,  98,  passim^  I  there  endeavored  to  explain  how 
opium,  only  one  grain,  was  sufficient  to  arrest  that 
complaint. 

But  first  let  me  make  one  admonition  on  the  prep- 
aration. When  a  practitioner  has  serious  work  on 
hand,  let  him  use  the  simplest  means  a'8  being  the 
most  sure  to  reach  the  end  he  has  in  view.  In  all 
serious  cases  where  real  work  is  to  be  done,  employ 
pure  opium.  Nature  has  made  it  perfect.  She  is  the 
greatest  and  wisest  chemist,  with  whom  no  one  can 
compete.  Pure  opium  contains  a  well  balanced  mix- 
ture of  homogeneous  ingredients,  the  removal  of  one 
of  which  will  proportionately  deteriorate  the  article. 
Pharmaceutists  have  tortured  opium  in  all  possible 
ways  to  improve  on  that  which  comes  perfect  from  the 
hand  of  nature,  and  by  their  scandalous  puffing  have 
imposed  on  weak  minds,  ^er  on  the  qui-vive  for  some- 
thing new;  in  cases  of  cholera,  abandon,  then,  all  fancy 
forms  of  opium — black  'Irop,  elixirs,  and  the  various 
salts  of  morphinCj  codeine,  narcotine — all  the  'ines, 

250.  In  Asiatic  cholera,  a  small  dose  of  opium,  not 
over  one  grain,  given  after  vomiting  has  continued 
long  enough  to  reject  the  new  and  noxious  matter 
poured  into  the  stomach,  will  calm  the  irritability  of 
the  organ,  and  save  the  patient  from  the  debilitating 
eflforts  at  vomiting,  no  longer  needed.  A  larger  dose 
might  so  paralyze  the  stomach  as  to  arrest  its  power 
9*       -'^ 


190 


ASIATIC  CHOLESA. 


of  ejecting  wbat  ought  to  be  discharged,  and  lock  it 
in,  to  the  injury  of  the  patient.  Should  the  dose  be 
rejected,  take  a  moment  of  repose  and  give  another, 
dry,  if  possible,  so  that  the  Volume  may  not  o£fend  a 
preternaturally  excitable  organ.  Should  this  dose  be 
retained,  in  fifteen  or  twenty  minutes  after  some 
agreeable  acid  drink,  mentioned  hereafter,  may  be 
given,  an  ounce  at  one  time;  this  being  retained,  re- 
peat it,  and  increase  the  quantity  and  the  frequency 
of  repetition  compatible  with  the  powers  of  retention. 
To  give  oftener  or  more  at  a  time  before  the  stomach 
will  retain  it  will  frustrate  the  object  sought. 

The  real  use  of  opium  here  is  simply  to  quiet  the 
excessive  irritability  of  the  stomach,  and  arrest  the 
frequent  vomiting,  the  efiForts  of  which  tend  greatly 
to  add  to  the  exhaustion  of  the  patient.  Opium  has 
been  combined  with  aromatics,  stimulants,  such  as 
ether,  ammonia,  etc.  It  is  doubtless  good,  but  the 
volume  of  the  dose  is  greater  than  the  viscus  will  en- 
dure, and  will  be  rejected.   Give  the  opium  dry. 

Opium  has  been  given  in  repeated  doses,  every 
half  hour,  regardless  of  a  stomach  filled  with  poison- 
ous matter  which  vomiting  must  discharge,  and  hav- 
ing succeeded  in  paralyzing  the  organ,  has  tended  to 
a  speedy  death.  Before  deciding  on  the  administ^'a- 
tion  of  opium,  one  important  consideration  must  be 
carefully  borne  in  mind,  that  is,  what  is  the  cause  of 


:,i 


TREATMENT. 


191 


the  Tomiting?  Let  us  examine  this  point.  It  is  cer- 
tain that  preyious  to  the  attack  the  stomach  was  in 
no  way  disordered;  therefore,  something  has  hap- 
pened to  disturb  it;  what  is  this  something?  Evi- 
dently, newly  created  choleraic  matter  poured,  or 
rather  oozed,  into  the  stomach,  which  offends  it,  and, 
like  all  offensive  matter  in  the  stomach,  vomiting  is 
the  remedy  nature  employs  to  rid  the  organ  of  what 
is  noxious.  As  this  matter  cannot  all  pass  the  pylo- 
rus into  the  intestines  it  will  be  rejected,  and  must 
be  got  rid  of,  to  a  great  extent,  before  it  will  be  pru- 
dent to  give  opium  and  thereby  arrest  the  rejective 
power  of  the  organ.  In  the  early  period  of  the  col- 
liquation  the  noxious  matter  is  rapidly  oozed  into  the 
stomach,  but  after  a  while  there  is  less  and  less  of  it 
so  furnished,  while  the  organ  once  offended  continues 
to  act  when  none  or  little  remains;  it  will  act  when 
all  choleraic  matter  has  ceased  to  be  present;  if  only 
water  be  admitted  in  a  quantity  greater  thau  the  in- 
duced irritability  will  endure,  this  will  be  rejected. 
It  is  this  persistent  irritability  that  opium  is  em- 
ployed to  allay. 

When  opium  is  administered  at  the  proper  time, 
and  in  proper  quantity,  it  will  not  only  allay  a  state 
of  vomiting,  which  is  no  longer  needed,  but  it  will 
also  soothe  the  whole  economy  in  a  notable  degree, 
and  pave  the  way  to  a  recovery.    Would  it  be  safe 


I 


192 


ASIATIC  CHOLERA. 


to  inject  the  opiate  hjpodermic&lly  in  cases  of  such 
great  irritability  of  the  stomach  that  much  difficulty 
to  retain  the  medicine  on  the  stomach  is  experi- 
enced? But  it  must  be  borne  in  mind  that  the  ob- 
ject is  to  arrest  useless  vomiting;  therefore,  the 
quantity  injected  ought  to  be  rery  small. 

251.  Water  J  cold  water,  is  the  ceaseless  cry  of  the 
patient  from  almost  the  first  onset  of  the  case.  This 
thirst  is  not  due  to  fever,  or  any  thing  like  fever,  for 
fever  does  not  and  cannot  exist  in  cholera;  it  is  due 
to  two  causes — a  perverted  sensation  of  heat,  like 
that  of  the  skin,  and  to  the  great  drain  which  has 
dried  up  the  tissues,  as  it  were.  During  the  early 
period  of  the  complaint,  while  vomiting  is  active, 
produced  by  the  presence  of  the  new  matter,  let  the 
patient  take  as  much  as  he  calls  for;  it  will  be  re- 
jected, of  course,  but  will  not  increase  the  vomiting. 
However,  when  the  colliquation  becomes  diminished 
or  exhausted,  care  must  be  had  in  mind  that  now 
the  vomiting  is  continued  from  induced  irritability 
after  the  exciting  cause  has  ceased  to  act.      «•  ^  .  .  ,  > 

252.  Drinks  are  loudly  called  for,  and  might  be 
given  under  the  conditions  already  mentioned,  were 
it  not  that  they  are  useless  in  the  early  period  of 
the  complaint,  since  they  cannot  be  absorbed  or  cir- 
culated, as  elsewhere  noticed.  There  is,  however, 
one  beverage^-^doubtless  there  are  others— which  I 


TREATMENT. 


193 


hare  found  grateful  and  uscftil.  It  may  be  called  a 
lemonade,  made  of  sweetened  water  acidulated  with 
tartaric  acid,  in  the  proportion  of  half  a  drachm  to 
a  tumblerful.  But  it  must  be  given  with  much  judg- 
ment, so  as  not  to  offend  the  stomach  by  volume.  I 
had  previously  tried  nitric  acid,  but  it  proved  offen- 
sive. When  phosphorus  was  suggested  as  needed  by 
the  system,  I  bethought  myself  of  substituting  phos- 
phoric acid  for  tartaric  acid,  but  being  satisfied  with 
tho  latter,  I  did  not  put  the  phosphoric  idea  into  exe- 
cution. 

253.  Phosphorus  has  been  prescribed  as  stated. 
Sec.  234 — upon  what  principle  I  cannot  imagine. 
The  common  stick  phosphorus  is  exceedingly  unman 
ageable,  and  on  this  account  I  would  recommend  to 
those  who  believe  in  its  utility  to  try  amorphous  phos- 
phorus, which  is  quite  manageable  and  pleasant  to 
take. 

264,  Hot  applications  have  already  been  men- 
tioned, and  are  useless,  besides  being  an  anr  oyance 
to  the  patient.  Experience  shows  that  a  patient  can- 
not be  warmed  by  external  means,  and  the  large 
amount  of  hot  saline  injections  into  the  veins  has  not 
contributed  to  the  warmth  of  the  patient.  Aeration 
of  the  red  part  of  the  blood  is  the  means  employed 
by  nature.  v^^ff  .  ^ 


.r-- 


194 


ASUTIO  CHOLERA. 


355.  CcUd  applications,  I  knew  one  case  of  cold 
bathing.  A  poor  man  had  just  lost  his  wife  ft*om 
cholera,  when  he  himself  was  attacked,  and,  like  all 
others,  suffered  from  a  feeling  of  heat;  he  found  his 
way  into  the  yard,  got  into  his  water-barrel,  re- 
mained in  it  some  twelve  hours,  when,  feeling  re- 
lieved, he  got  back  into  the  house  nearly  recovered, 
when  he  found  his  dead  wife  where  he  had  left  her. 

266.  The  foregoing  analysis  of  the  various  rem- 
edies and  modes  of  treatment  employed  in  cholera 
show  clearly  that  the  authors  were  at  a  loss  what, 
to  do,  and  quite  bewildered;  and  that  no  correct 
opinion  existed  regarding  the  immediate  cause,  nor  is 
that  uncertainty  yet  removed.  Let  us  turn  and  be 
honest,  cease  our  pretensions  to  a  knowledge  that  we 
do  not  possess,  discard  the  foregoing  errors,  and  by  so 
doing  disembarras  ourselves  of  a  false,  useless  and  of- 
tentimes iigurious  medication,  and  commence  anew. 
Let  us  throw  theory  overboard  as  useless  now,  and 
try  instead  a  reasonable,  empirical  and  an  expectant 
treatment,  until,  little  by  little,  we  arrive  at  some- 

'  thing  that  can  be  relied  upon.  In  this  way  we  shall 
do  no  harm,  and  not  hu7  ry  the  patient  to  his  end,  as 
has  too  often  been  done.    We  still  meet  with  prac- 

'  titioners  who  assert  boldly  that  cholera  is  quite 
manageable,  and  boast  of  the  many  cures  they  have 
made. 


TREATMEKT. 


195 


^  257.  Dialogue.  You  deceive  yourself,  Doctor; 
neither  you  nor  any  one  else  has  over  cured  a  case  of 
cholera. 

Yes,  I  have  cured  many;  I  can  prove  what  I  sfty. 
There  is  Mr.  —  and  Mrs.  — ,  and  many  others,  who 
were  very  ill;  I  cured  them,  and  they  are  now  alive, 
and  will  substantiate  what  I  say. 

No  doubt  you  had  such  patients;  that  you  attended 
them,  and  that  they  are  alive  to  day;  so  fur  true:  but 
how  many  cases  have  you  had,  and  how  many  of  them 
have  survived  ? 

'I  have  cured  nearly  every  case — at  least  nineteen 
out  of  twenty. 

■  It  is  likely  that  you  trust  more  to  memory  than  to 
a  correct  list  of  your  cases  and  alleged  cures.  All 
history,  on  which  the  slightest  reliance  can  bo  placed, 
and  respect  accorded,  shows  that  the  roost  favorable 
result  has  been  the  recovery  of  two  in  three  cases; 
one-third  of  the  attacks  have  died.  There  are 
instances  of  one-half,  even  of  two-thirds,  of  the 
attacks  ending  fatally  in  a  few  places  invaded.  If 
you  can  be  persuaded  of  your  error,  you  will,  on  a 
future  occasion,  judge  with  more  accuracy  than  you 
now  do,  and  be  in  a  better  state  of  mind  to  benefit 
a  patient  than  heretofore. 

258.  Expectant  treatment  aided  by  an  enlightened 
empiricism.    Before  deciding  on  a  method  of  treat- 


loe 


ASIATIC   CHOLERA. 


ing  a  case  of  cholera,  we  must  make  up  our  mind 
regarding  the  nature  of  the  complaint— that  is,  tho 
immediate  mode  in  which  the  poison  acts.  It  has 
been  shown  (Sec.  210)  that  this  mode  of  action  is 
one  that  converts  a  portion  of  the  body  into  a  liquid 
form,  and  that  the  liquid  so  created  will  oozo  through 
the  tissues  and  out  of  the  body  by  way  of  tho  intes- 
tinal, mucous  and  dermoid  surfaces.  Whether  the 
liquid  which  escapes  existed  in  the  tissues  already 
formed  before  it  reached  the  surfaces,  or  that  it  put 
on  the  liquid  form  on  arriving  at  the  surfaces,  is  uncer- 
tain; but  in  any  case,  having  arrived  there,  and  been 
poured  into  the  alimentary  canal,  it  must  not  be 
locked  up  therein  by  any  medication  we  may  employ, 
should  we  possess  a  medicine  capable  of  arresting  its 
discharge.  There  are  well  authenticated  cases  in 
which  no  discharges  have  taken  place,  unless  it  is  that 
which  escapes  by  the  skin.  In  such  cases  it  is  evi- 
dent that  the  colliquated  matter  has  not  entered  the 
stomach  and  intestines,  but  is  retained  within  the 
tissues;  perhaps  it  did  not  go  through  the  necessary 
phases  that  precede  the  liquid  form.  However  this 
may  be,  it  is  of  little  importance,  in  a  medical  point 
of  view,  since  all  such  cases  are  mortal  and  cannot 
be  helped  by  medication.  u    . 

259.  A  practitioner  seldom  sees  the  commence- 
ment of  a  case,  unless  he  should  happen  to  be  near 


TREATMENT. 


197 


ii 


the  person  attacked.  When  such  an  opportunity 
occurs,  the  first  complaint  of  the  patient  is  that  he 
feels  an  indescribable  feeling  of  general  uneasiness — 
something  wrong  at  the  stomach — a  mawkish  sensa- 
tion, and  a  rapidly  increasing  debility.  He  has  a 
call  to  stool,  which  he  obeys;  a  large  motion  escapes, 
unaccompanied  by  any  pain  in  the  bowels  or  the 
least  feeling  of  colic.  He  has  scarcely  relieved  the 
bowels  when  he  feels  another  call  and  has  another 
motion,  succeeded  by  another,  and  so  on.  He  now 
begins  to  experience  some  thirst  and  a  pasty  mouth, 
destitute  of  taste,  soon  followed  by  vomiting;  a  damp 
skin,  which  is  cold  to  another,  but  not  to  himself,  and 
which  he  soon  complains  of  as  being  hot.  Such  were 
the  feelings  of  the  author  when  he  was  attacked  at  a 
time  when  he  was  quite  woll,  in  the  forenoon.  In 
general  a  doctor  does  not.  see  his  case  until  it  has 
advanced  to  rapid  purging,  vomiting,  cyanosis  and 
cold  surface. 

360.  Meeting  with  a  case  in  this  stage,  the  first 
prescription  must  be  to  inculcate  as  much  quietude, 
or  cessation  of  that  tossing  about  from  side  to  side 
on  the  bed,  as  the  patient  can  be  prevailed  on  to 
maintain,  for  such  movement  of  the  body  increases 
the  peristaltic  action  of  the  bowels  and  the  vomiting. 

261.  While  vomiting  of  choleraic  matter  contin- 
ues, there  can  be  no  objection  against  allowing  the 


ii' 


I 


y' 


198 


ASIATIC   CHOLGBA. 


patient  to  drink  moderately,  some  say  freely,  of  what 
he  so  ardently  calls  for — cold  water;  for,  whether 
he  drink  or  not,  he  will  vomit  as  long  as  the  stomach 
receives  choleraic  matter  into  it,  and  which  ought  to 
and  must  come  away,  as  very  little  of  it  will  pass 
into  the  intestines  and  escape  by  that  canal.  It  is  on 
this  account  that  some  practitioners  have  advised 
emetics,  but  of  which  there  is  no  need,  since  the  mor- 
bid matter  is  an  emetic  of  itself.  As  the  colliqua- 
tion  does  not  last  long,  the  oozing  into  the  stomach, 
at  first  rapid  and  in  great  quantity,  soon  diminishes 
and  but  little  will  remain  after  the  vomiting  will 
have  continued  for  a  while;  but  the  irritability  it  has 
set  up  in  the  stomach  will  continue  when  little  or 
none  remains.  This  irritability  is  so  persistent  as  to 
force  the  stomach  to  reject  even  the  water  it  so  much 
craves,  and  which  it  cannot  endure  the  presence  of, 
even  in  a  very  small  quantity. 

263.  It  is  now  time  to  administer  the  opiate,  to 
calm  a  useless  irritability  which  excites  efforts  to 
vomit  when  th«  need  and  the  good  of  vomiting  has 
passed  away,  and  which,  if  allowed  to  go  on,  will 
greatly  add  to  the  prostration — the  patient  already 
exhausted.  Give,  then,  the  opiate  in  moderate  dose, 
not  more  than  a  grain  (Sec.  250);  if  it  stay  down  for 
only  ten  minutes  it  will  have,  in  that  short  space  of 
time,  diminished  the  irritability,  to  a  proportionate 


TREATMENT. 


199 


for 
of 


degree,  and  tend  to  its  remaining  fifteen  minutes, 
perhaps  to  continue  down.  Should  it  be  rejected, 
repeat  the  dose.  When  this  is  well  conducted,  per- 
fect stillness  observed,  even  of  speech,  on  the  part  of 
the  patient  and  the  bystanders,  one  dose,  at  most, 
will  suffice  to  calm  the  organ  and  soothe  the  whole 
system.  When  this  is  established — say  in  half  an 
hour — we  may  venture  to  give  a  tablespoonful  of 
water  or  tartaric  lemonade;  in  a  few  minutes  more 
repeat  this  quantity,  gra  jually  increasing  the  quantity 
with  caution  and  judgment,  so  as  not  to  set  vomiting 
once  more  agoing  by  the  presence  of  a  volume  which 
the  stomach  will  not  endure.  In  a  short  time  more 
the  patient  can  be  safely  supplied  with  as  much  as  is 
good  for  him,  but  never  more  at  one  time  than  three 
to  four  ounces  at  a  single  draught. 

263.  A  larger  quantity  of  opium  than  what  has 
been  recommended  will  overdo  and  paralyze  the  de- 
bilitated stomach  beyond  a  safe  point.  As  soon  as 
it  is  ascertained  that  the  stomach  will  bear  it,  a  cup 
of  good  broth  or  beef  tea  may  be  added,  and  in  time 
other  appropriate  nutriment. 

864.  Diarrhoea,  previous  to  an  attack  of  cholera, 
or  cholerine,  as  it  has  been  called.  It  is  doubtful 
whether  or  not  this  affection  of  the  bowels  is  really 
an  antecedent  of  cholera,  or  that  it  is  not  either  an 
ordinary  looseness  so  commonly  met  with  at  all  times 


200 


ASIATIC   CHOLERA. 


when  no  cholera  prevails,  or  in  many  cases  is  the 
result  of  mental  anxiety,  disturbing  the  bowels  in  a 
time  of  great  general  alarm,  may  be  questioned. 
This  doubt  is  strengthened  by  the  facility  with  which 
the  feculent  discharges  can  be  suppressed  and  no 
cholera  follow,  also  by  the  fact  that  this  diarrhoea 
may  last  several  days  and  then  cease,  even  without 
medication,  and  that  the  matter  discharged  is  purely 
feculent,  and  has  not  the  least  resemblance  to  chol- 
eraic discharges.  However,  there  is  nothing  re- 
markable in  the  fact  that  some  of  the  cases  of  "  chol- 
erine" should  be  followed  by  the  supervention  of 
real  cholera,  since  we  find  the  latter  attacking  pa- 
tients extremely  ill  of  various  fevers  during  any  of 
their  stages,  at  their  beginning,  middle  or  end;  such 
as  variola,  typhus,  etc. 

266.  In  these  cases  of  diarrhoea  it  will  be  well  to 
give  the  patient  an  opiate,  one  grain  of  opium,  or 
thirty  drops  of  laudanum,  in  a  draught  of  some  cor- 
dial, spirit  or  carminativ^  mixture — but  not  more 
than  one  grain  or  its  equivalent.  The  patient  ought 
to  lie  down  comfortably  warm,  and  remain  as  quiet 
as  possible.  Quietude  is  particularly  called  for  in 
every  kind  of  bowel  complaint,  for  exercise  or  mo- 
tion increases  the  peristaltic  movement  of  the  in- 
testines, which,  of  itself,  keeps  up  an  irritation  and 
the  frequency  of  the  dejections. 


■ffl 


TREATMENT. 


201 


These  two  elements  of  treatment — the  opium  and 
the  quietude — will  be  sure  to  moderate  if  not  arrest 
the  passages.  The  practitioner  on  his  next  visit  to 
the  patient,  at  the  expiration  of  three  or  four  hours, 
will  find  him  better,  and  ought,  with  a  cheerful  coun- 
tenance, to  encourage  his  patient  and  assure  him  that 
his  case  is  under  control.  The  relief  that  the  patient 
now  experiences,  and  the  hopeful  assurance  of  his 
physician,  will  calm  that  anxiety  which  was  a  large 
cause  of  the  bowel  complaint. 

Should  there  remain  a  tendency  to  purgation  still, 
the  same  dose  may,  or  rather  ought  to  be  repeated, 
which,  with  a  persistence  of  repose,  moderate  warmth, 
and  a  few  hours  of  sleep,  will  produce  some  twelve 
or  more  hours'  suspension  of  the  complaint.  Should 
the  practitioner,  after  this  interval  of  relief,  judge 
proper  to  move  the  bowels  gently,  with  a  view  of  dis- 
charging any  of  the  diarrhoeic  matter  that  he  may 
suppose  has  remained,  he  may  do  so  by  means  of  a 
small  dose  of  castor-oil,  or  a  little  compound  tincture 
of  rhubarb.  When  this  has  operated  to  his  satisfac- 
tion, he  may  repeat  the  anodyne  already  prescribed, 
in  order  to  completely  calm  the  intestinal  relaxation. 
There  are  few  cases  that  will  not  readily  yield  to  this 
soothing  treatment.  No  irritating  laxative — such  as 
salts,  magnesia,  senna,  or  any  included  under  the 


202 


ASIATIC   CHOLERA. 


names  purgative,  cathartic,  drastic — should  be  per- 
mitted to  be  taken. 

266.  When  the  relax  has  been  suppressed  the 
patien  '^  may  be  allowed  to  leave  his  bed,  should  he  be 
desirous  of  so  doing;  still,  it  must  be  borne  in  mind 
that  repose  of  the  body  gives  repose  to  the  intestines. 
He  may  be  allowed  a  reasonable  amount  of  suste- 
nance, and  rather  of  that  kind  he  has  been  habituated 
to  and  for  which  he  has  an  appetite;  but  thin  gruel, 
weak  broths  and  slops  had  better  be  dispensed  with. 
A  small  glass  of  any  agreeable  cordial  ought  to  be 
taken,  or  a  glass  of  good  wine,  such  as  Madeira, 
Teneriffe  or  Port,  any  sound  old  Spanish  wine;  but 
let  him  shun  that  villainous  compound,  now  so  fash- 
ionable, sold  under  the  name  of  Sherry.  This  last 
named  wine,  even  when  not  adulterated,  which  is 
never  the  case  now,  is  at  best  a  shabby  substitute  for 
the  warm  southern  wines  already  recommended.  As 
regards  the  light  French  wines,  they  are  too  watery 
and  destitute  of  body,  as  it  is  called,  to  be  useful 
as  an  auxiliary  to  the  medical  treatment  of  the  diar- 
rhoea under  consideration.  Shun  groceries,  retail  or 
wholesale,  if  possible,  for  neither  purity  nor  truth  re- 
side in  those  haunts  of  adulteration.  Should  difficulty 
be  experienced  in  procuring  good  wine,  dispense  with 
it,  and  make  some  kind  of  palatable  cordial  or  punch, 
with  good  spirits. 


TREATMENT. 


208 


267.  Astounding  cases,  and  cases  without  dis- 
charges, always  terminate  rapidly  in  death;  conse- 
quently they  have  no  sequel.  On  dissection,  no  lesion 
of  any  kind  can  be  detected;  the  patient  has  been 
simply  poisoned. 

268.  Cases  accompanied  with  rapid  and  copious 
discharges,  but  in  which  the  impulse  of  the  heart  is 
only  weakened,  the  capillary  circulation,  particularly 
that  portion  which  belongs  to  the  veins,  is  still  car- 
ried on,  although  feebly,  no  cyanosis  existing,  and 
little  or  no  cramps  complained  of,  will  run  their 
course  to  its  termination  in  a  short  time,  not  much 
over,  or  even  less,  than  six  to  twelve  hours.  Soon 
after  the  gastric  discharges  and  that  by  the  skin 
have  ceased,  the  patient  commences  to  repose,  and 
warmth  returns;  he  will  fall  into  a  refreshing  sleep, 
out  of  which  he  awakens  perfectly  restored  to  health, 
excepting  some  slight  weakness  experienced  on  exer- 
cise, and  loss  of  his  usual  fullness,  both  of  which  are 
soon  restored;  he  is  able  to  and  does  go  about,  feel- 
ing well,  the  next  day. 

269.  Such  a  case,  withoiit  premonition,  sudden, 
severe,  rapid  in  its  course,  termination  and  recovery, 
leaving  no  trace  of  its  fury  discoverable  in  the  sys- 
tem, goes  far  to  support  the  statement,  cholera  is 
not  a  disease;  but  that  the  disorder  must  be  attrib- 
uted to   some  transient  cause—a  poison  received 


204 


ASIATIC   CHOLEBA. 


from  without,  the  potency  of  which  is  variable  in 
different  persons,  astounding  in  some,  seyere  in 
others,  less  in  many. 

370.  There  are  cases  to  all  appearance  of  the  same 
degree  of  severity  as  described  in  Sec.  268,  and 
which  recover  in  the  same  way,  but  in  which  debility 
is  more  marked,  gradually  increases  day  by  day 
until  in  three,  four,  or  five  days  the  patient  sinks 
without  a  struggle. 

271.  Similar  cases,  which  have  in  addition  a  slight 
cyanosis,  do  not  recover  so  rapidly  and  completely  as 
268;  but  advance  slowly  in  warmth  and  in  conva-^ 
lescence  to  ultimate  perfect  recovery.  Cyanosis  in- 
dicates a  profound  impression  made  by  the  poison. 
These  patients  require  repose,  good  nursing,  a  judi- 
cious use  of  cordials,  light  bitter  infusions  and  careful 
doses  of  nourishment.  Many  of  these  cases  after 
struggling  along  for  a  few  days,  giving  hope,  have  to 
yield  to  a  failing  economy  that  has  suffered  more  than 
it  can  resist. 

273.  Severe  cases,  accompanied  with  a  degree  of 
cyanosis  greater  than  in  271,  occasionally  weather 
the  choleraic  storm,  followed  by  a  strong  effort  of 
the  constitution  to  convalesce.  The  pulse  is  feeble, 
the  temperature  slowly  returns,  the  stasis  in  the 
skin  diminishes  in  color  from  leaden  to  light  purple, 
and  in  a  few  days  to  that  of  a  weak  scarlatina.   The 


TREATMENT. 


205 


eyes  are  less  deeply  set  in  the  orbits  than  they  were; 
the  conjunctivaB  may  appear  slightly  pinkish;  the 
corneaB  are  moist,  but  not  sufficiently  so  to  give  the 
clear  sheen  seen  in  health,  since  the  lachrymal  secre- 
tion is  scanty,  as  are  all  other  secretions;  urine  is 
formed  in  small  quantity,  and  strangury  has  ceased, 
abdominal  contractions  no  longer  pressing  the  base 
of  the  bladder  into  the  meatus.  (Sec.  135.)  Thirst 
continues,  because  repletion  of  fluid  is  not  yet  com- 
plete; should  the  patient  sleep  with  the  mouth  open, 
or  keep  it  open  while  awake,  the  tongue  becomes  dry 
and  rough,  even  brown  colored;  there  is  little 
appetite  excepting  for  fluids,  a  little  of  which,  with 
the  nutriment  that  happens  to  be  mixed  with  it,  may 
pass  the  pylorus  in  some  degree  digested,  perhaps, 
and  which  will  furnish  material  for  a  scanty  stool, 
not  much  affected  with  bile.  The  temperature  of  the 
surface  is  low,  but  as  the  Ikin  is  dry  and  cannot 
evaporate,  it  gives  the  sensation  of  a  degree  of  heat 
that  does  not  exist  in  reality;  neither  is  this  sensation 
of  heat,  nor  the  thirst,  nor  the  parched  mouth,  due  to 
fever — there  is  none.  I  closely  watched  several 
cases,  particularly  those  of  two  ladies.  The  mind 
was  slightly  blunted,  it  is  true,  and  like  in  fevers  the 
patients  looked  slightly  anxious,  but  were  quite  clear 
in  mind  to  the  last.  They  were  rather  restless,  soon 
weary  of  one  position;  one  would  get  up  of  herself, 
10 


206 


ASIATIC   CHOLERA. 


flit  on  her  chair  for  a  while,  say  but  little,  and  return 
to  bed;  none  complained  of  that  false  heat  so  con- 
stantly present  in  sensation  during  colliquation.  One 
of  these  died  on  the  10th  day,  with  her  senses,  as  did 
the  other  on  the  12th.  Some  such  patients  gradually 
recovered,  much  deteriorated  in  constitution  for 
some  months. 

The  treatment  of  alleged  typhoid  state  ought  to 
bo  principally  expectant.  Husband  the  strength  of 
the  patient  by  avoiding  any  thing  that  can  fatigue, 
waste,  or  exhaust  the  patient.  Give  such  nutriment 
as  the  appetite  prefers,  and  in  such  quantities  as  the  \ 
stomach  can  master,  not  more.  Palatable  fluids,  and 
now,  light  French  wines  freely,  unless  disagreeable 
to  the  patient;  in  this  case  give  cordials  at  judicious  ■ 
intervals.  Tepid  baths,  when  the  patient  can  get 
into  them  without  fatigue;  in  their  stead,  sponging 
frequently.  This  external  wetting  will  contribute  to 
supply  the  watery  waste  that  has  taken  place,  will 
aerate  the  cyanosed  surface,  and  prove  a  grateful 
anodyne  to  the  feelings.  Never  give  a  pharmaceutical 
stimulant  when  a  natural  one,  like  wine,  can  be  had. 
Shun  medication,  so-called. 


